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Open Access Case report

Phlegmonous colitis: another source of sepsis in cirrhotic patients?

Thomas Holzer1, Pascal Gervaz1*, Laurent Spahr2, Thomas McKee3, Pascal Bucher1 and Philippe Morel1

Author Affiliations

1 Department of Surgery, Geneva University Hospital and Medical School, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland

2 Department of Gastroenterology, Geneva University Hospital and Medical School, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland

3 Department of Pathology, Geneva University Hospital and Medical School, 1 rue Michel-Servet, 1211 Geneva, Switzerland

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BMC Gastroenterology 2009, 9:94  doi:10.1186/1471-230X-9-94

Published: 15 December 2009

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.