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J Korean Soc Emerg Med > Volume 23(3); 2012 > Article
Journal of The Korean Society of Emergency Medicine 2012;23(3): 439-442.
Typhoid Fever Complicated by Intussusception, Splenic Infarction, and Hepatitis
Seong Eun Yang, Sung Hee Jung, Sae Hee Kim, Anna Kim, Hyeong Kug Kim, Hyun Jin Moon, Jin A Lee, Yong Hun Choi, Seong Min Jo, Young Mo Yang
1Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea. jsh@eulji.ac.kr
2Department of Emergency Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea.
Salmonella typhi infections usually manifest with high fever and gastrointestinal symptoms, however, occurrence of severe complications in other organs, such as pneumonitis, bronchitis, hepatitis, nephritis, encephalitis, and osteomyelitis, is possible. Although common surgical complications include ileal perforation and gastrointestinal haemorrhage, few cases of intussusception have been reported. Splenic infarction is another uncommon complication. In this report, we present a case of typhoid fever complicated with simultaneous small bowel intussusception and splenic infarction. A 27-year-old male patient with no previous history of interest underwent examination for fever, acute abdominal pain, and watery diarrhea of seven days duration. Findings on the initial examination indicated fever of 39.1degrees C, a distended abdomen with direct and rebound tenderness of diffuse localization, and rigidity. Abdominal computed tomography showed hepatomegaly, multiple lymphadenopathies, multiple segmental splenic infarctions, and small bowel ileus with intussusception, however, findings from the small bowel enema study showed spontaneous resolution of the intussusception. Despite antibiotic therapy, abdominal symptoms continued, therefore, the patient underwent exploratory laparotomy with suspicion of intestinal perforation. Surgical findings included multiple enlarged lymphadenopathies and coarse appearance of the liver, but no perforation was found. Results of the Widal test showed positivity for flagellar (H), somatic (O) and A antigens (1:640 dilutions each). Blood cultures showed Salmonella typhi. lymph nodes and biopsy showed mesenteric lymphadenitis, with enlarged lymph nodes due to distension of the sinusoids by macrophages, which showed erythrophagocytosis and tingible bodies. In addition, liver biopsy showed a granulomatous aggregate comprised of macrophages with an epithelioid configuration. After intravenous administration of antibiotics, the patient showed progressive improvement and was discharged for outpatient department follow up.
Key words: Typhoid fever, Intussusception, Splenic infarction, Typhoid hepatitis
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