1 – Unidade de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.;
2 – Serviço de Cirurgia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.;
3 – Unidade de Infeciologia, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.
- 30th Annual Meeting of the European Society for Paediatric Infectious Diseases. Thessaloniki,Greece.May 8-12,2012.
Introduction: Bacterial enteritis is a risk factor for intussusception but, in Shigella gastroenteritis, intestinal complications are rare (relative risk 2.5%).
Case report: Child, male, 13 months, previously healthy, hospitalized for high fever, vomiting and liquid stools with fresh blood with six days of evolution. On admission was prostrate, dehydrated and had periods that alternated between weeping and inconsolable cry. The mucous membranes were pale and the abdomen very tender. Analytically 19,900 leukocytes/mL, ESR 85 mm/h, C-reactive protein 41.7mg/L, serum sodium 129 mmol/L. He performed abdominal ultrasound that showed multiple mesenteric lymph nodes in ileocecal valve, associated with a fixed image of intestinal loops in the right abdominal quadrant. Because it was not possible to exclude intussusception an enema was performed, verifying rapid progression of the air filling the entire colon and ileum. Shigella flexneri, isolated in the stool culture, was resistant to ampicillin and cephalosporins 1st and 2nd generation, but sensitive to cefotaxime who was administred for 10 days. In the 2nd day of hospitalization he was afebrile the with good food tolerance and progressive improvement of abdominal complaints. A posterior abdominal ultrasound revealed no changes.
Comments: The gastroenteritis may present with high fever and bloody diarrhea but associated crampy abdominal pain and inconsolable cry should raise the suspicion of intussusception. In shigellosis, the male gender, below the age of two years and hypertrophy of Peyer's patches in ileum usually 30 days after infection, are risk factors for complications. In these cases antibiotic therapy is essential to improve prognosis.
Key-words: shigella gastroenteritis, risk, intussusception.