Campylobacter colitis: Rare cause of toxic megacolon

Bowel Ischemia Secondary to Campylobacter Enterocolitis: A Case Series and Review of the Literature

Campylobacter is the most common cause of diarrheal illness worldwide and is generally self-limiting. We present two cases of Campylobacter enterocolitis complicated by bowel ischemia in a 79-year-old male and a 53-year-old male, both presenting with abdominal pain and diarrhea and elevated lactate and C-reactive protein (CRP) levels. CT demonstrated common findings of pneumatosis intestinalis (PI) and portal venous gas. Exploratory laparotomy performed on the former demonstrated extensive small bowel infarction that was noncompatible with life and he was palliated postoperatively. The latter improved clinically after resection of the ischemic section of the small bowel with primary stapled anastomosis and closure. Clinicians need to be aware of the potentially fatal complications of Campylobacter-associated enterocolitis and should maintain a high clinical index of suspicion so that early surgical intervention can be considered in this patient population.

Campylobacter jejuni pancolitis complicated by toxic megacolon in an immunocompetent host

This is an unusual case of a middle-aged, immunocompetent man who developed toxic megacolon (TM) secondary to infection with a normally harmless bug, Campylobacter jejuni He presented with diarrhoea, fever and abdominal pain. Faecal cultures were positive for C. jejuni However, the patient did not show significant improvement after a trial of intravenous antibiotics. Bowel segment dilation on a CT scan combined with systemic signs (fever) led to the diagnosis of TM. A subtotal colectomy was planned but an unexpected positive response to conservative therapy deferred the surgery. Our case emphasises the crucial role that bowel rest and good nutritional support play in treating TM of infectious aetiology and how it can help avoid the need for a life-altering subtotal colectomy and ileostomy. For such presentations we also highlight how empirical steroid therapy or diagnostic sigmoidoscopy for suspected underlying ulcerative colitis can be detrimental to patient outcomes.

Campylobacter colitis leads to toxic megacolon and multiple organ failure

A 58-year-old woman presented to the emergency department in a district general hospital with severe abdominal pain and diarrhoea, after collapsing at home. She was admitted to the intensive care unit (ICU) in septic shock, and with acute kidney injury. An initial CT scan was suggestive of colitis. She was treated for suspected gastroenteritis and her microbiology results showed Campylobacter coli as the causative organism. She failed to respond to antibiotics, and underwent serial contrast CTs which showed no progression of colitis. Colonoscopy performed on day 10 of her admission, however, revealed fulminant colitis. After a multidisciplinary meeting among gastroenterologists, general surgeons and intensivists, the patient underwent total colectomy with ileostomy. She made a slow but steady recovery in ICU, and subsequently in the ward, and was discharged to a local community hospital for further rehabilitation.