Ileocecal Obstruction Secondary to Campylobacter Jejuni Ileitis

Ileocecal Obstruction Secondary to Campylobacter jejuni Ileitis

T. N. Diem Vu1, Ryan Watkins1, Yuri Hanada2; Daniel A. Schupack2, Nicholas R. Oblizajek2, Heidi K. Chua3, Konstantinos A. Papadakis2 1 Department of Surgery, Mayo Clinic College of Education and Research; 2 Division of Gastroenterology and Hepatology, Mayo Clinic,; 3 Division of Colon and Rectal Surgery, Mayo Clinic, Mayo Clinic, Rochester, MN

Background He denied family history of IBD or other gastrointestinal Given the recurrent obstructions, the patient consented to This case features an adult with classic symptoms disorders. He had no personal history of abdominal surgery. He laparoscopic exploration. The small bowel, colon and bowel of ileitis with a negative history of IBD, as well as had never smoked and consumed alcoholic beverages on a mesentery all appeared normal without any stigmata of IBD. A a history positive for travel in an endemic area Ileitis is classically associated with inflammatory social basis. He took occasional ibuprofen for musculoskeletal laparoscopic ileocecectomy was performed along with a side-to- for Campylobacter. One other case report of an bowel disease (IBD), but several infections can also aches. The patient did endorse recent travel to South Africa side stapled ileocolonic anastomosis. The patient tolerated the adult patient with severe campylobacteriosis cause inflammation/obstruction of the terminal ileum. three months prior to the onset of his symptoms. procedure well and was dismissed on postoperative day three described a 78 year-old male with three months of Presentation is usually acute and characterized by when he was tolerating oral intake, passing stool and flatus, diarrhea, with severe erythema, edema, ulceration right abdominal pain. During this hospitalization, a stool pathogen panel walking, and only using oral analgesics. and necrosis of the ileal and cecal mucosa on demonstrated Campylobacter jejuni infection. The patient colonoscopy5. The patient was started on empiric was empirically treated with azithromycin. His symptoms The patient’s symptoms resolved and he reported no issues antibiotics, but developed bowel wall pneumatosis Case Report resolved and he was discharged from the hospital. during his follow-up appointment four weeks after surgery. and renal failure, then progressed to multiorgan system failure and death. The patient’s stool cultures and endoscopic biopsy histology revealed infectious The patient was an otherwise healthy and fit 24 year- ileocolitis and isolation of Campylobacter jejuni5. old male. He was awakened from sleep by sudden Final pathology of the excised specimen noted markedly onset and severe right abdominal pain, nausea and increased eosinophils (>100/high power field) in the muscularis There is still a possibility that our patient developed non-bloody emesis. Within a few hours, he propria in the region of the ileocecal valve, accompanied by eosinophilic gastroenteritis limited to the ileocecal presented to the Emergency Department. His vital submucosal fibrosis, prominent Peyer patches, and patchy region causing recurrent bowel obstruction, but the signs, white blood cell count, electrolytes, and lactate mucosal injury. The appendix was unremarkable. No patient’s recent travel to an area where macrolide- were all within normal limits. granulomas, parasite eggs or worms, or neoplasm were resistant Campylobacter is known to be endemic,

identified. Immunoperoxidase studies were negative for CD1a as well as positive stool culture, are convincing for The patient denied any B symptoms, perianal and Langerin. a case of ileocecal obstruction secondary to symptoms, skin rashes, mouth ulcers, eye symptoms, Campylobacter jejuni ileitis. or joint pains. His prior bowel movements had been regular and non-bloody.

Discussion Conclusion

Ileitis is classically associated with IBD, but several infections Acute ileitis is an infrequent gastrointestinal can also cause inflammation or obstruction of the terminal ileum. disorder, and ileitis caused by infectious Such pathogens include Campylobacter jejuni, Yersinia pathogens is rarer still. After more common non- enterocolitica, Salmonella enteritidis and cytomegalovirus in infectious etiologies are excluded, infection by He experienced recurrence of the same symptoms and a repeat immunocompromised patients1. Clinical presentation is usually Campylobacter and other like organisms should CT scan of his abdomen demonstrated the same ileocecal acute and characterized by right abdominal pain. Other be considered, especially in patients with recent stricture, with progression of upstream bowel distension. associated symptoms may include diarrhea, fever, and nausea. travel history. Other causes of ileitis that should be considered in patient who present with bowel obstruction may include eosinophilic Subsequent gastroenteritis2, vasculitis, ischemia, drug-induced ileitis, References colonoscopy metastatic cancer and rarely, endometriosis3. demonstrated 1. Molina Gutiérrez MA, Martínez-Ojinaga Nodal E, Piñán a stricture at Campylobacter jejuni is a major cause of human the ileocecal Díez J, et al. Acute Terminal Ileitis in Children. Pediatr gastroenteritis, causing an estimated 96 million cases Emerg Care. 2019;35(4):249-251. valve with worldwide annually 4. This organism is a Gram-negative, non- doi:10.1097/pec.0000000000001461 ulcerated, spore forming, curved bacillus that is oxygen-sensitive and 2. Yun MY, Cho YU, Park IS, et al. Eosinophilic friable ileal thermosensitive, growing optimally at 42°C4. Campylobacter is gastroenteritis presenting as small bowel obstruction: A mucosa 2 cm transmitted to humans via the consumption of undercooked case report and review of the literature. World J Gastroenterol. 2007;13(11):1758-1760. proximal to meat, especially poultry4. In South Africa, Campylobacter has the valve. The doi:10.3748/wjg.v13.i11.1758 been found in a third of chicken carcasses from supermarkets 3. DiLauro S, Crum-Cianflone N. Ileitis: When It Is Not stricture was and butchers4. Crohn’s Disease. Curr Gastroenterol Rep. 2010;12(4):249- <1 cm in 258. doi:10.1007/s11894-010-0112-5.Ileitis length, and Campylobacteriosis is characterized by watery diarrhea, 4. Habib I. Campylobacter at the Human – Food Interface : was easily abdominal pain, fever, malaise and emesis4. Enteric The African Perspective. :1-30. 5. Magaz-Martinez M, Garrido-Botella A, Pons-Renedo F, et traversed and Campylobacter infection is known to start in the jejunum and CT of the abdomen and pelvis with IV contrast al. Fatal Campylobacter jejuni ileocolitis. Rev Espla dilated. progress distally5. Campylobacteriosis is usually self-limited demonstrated multiple distended loops of ileum with Engermedades Dig. 2016;108(10):662-663. Biopsy of the terminal ileum during this endoscopic evaluation disease and can be treated with macrolides, but in South Africa doi:10.1086/423282 small bowel fecalization. demonstrated patchy mild active chronic ileitis without dysplasia as much as 50% of human Campylobacter jejuni isolates have or granuloma. His right and left colonic biopsies were normal. been found to be resistant to azithromycin4.