Phlegmonous colitis: another source of sepsis in cirrhotic patients?

Abstract

Background: The clinical relevance of phlegmonous colitis (PC), a rare autopsy finding in cirrhotic patients, is poorly documented. We postulated that PC might be a source of sepsis in patients with portal hypertensive colopathy (PHC).

Case presentation: We report three cirrhotic patients who were admitted with abdominal sepsis and who illustrate, to various degrees, the clinico-pathological sequence of colonic alterations associated with portal hypertension. Two cirrhotic patients with PHC developed gram-negative bacteraemia and quickly responded to intravenous antibiotics. Another cirrhotic patient underwent emergency colectomy for PC, and subsequently died from multiple organ failure. Histological alterations in the operative specimen included: a) mucosal ulcerations; b) disseminated micro-abscesses in the submucosa; and c) a severe vasculopathy leading to complete obliteration of submucosal blood vessels.

Conclusions: These data suggest that cirrhotic patients with PHC may progress towards PC, which, in turn, may be the cause for life-threatening sepsis.

Figure 1

CT scan of case 1 showing extensive oedema of the right a transverse colon, as well as cirrhotic alterations of the liver.

Figure 2

CT scan of case 2 showing again extensive inflammation of the entire colon (pancolitis), with oedema and thickening of the large intestine wall.

Figure 3

Intra-operative aspect of the ascending colon of case 3. The colon was indurated, congestive, thickened, the general appearance being somewhat similar to acute mesenteric vein thrombosis.

Figure 4

Histological features of the operative specimen, showing numerous micro-abscesses in the submucosa (asterisk) as well as deep mucosal ulceration (arrow).

Figure 5

Histological features of the operative specimen, showing in addition to confluent micro-abscesses in the submucosa, a severe vasculopathy with disseminated venous thrombosis.