Franklin Fontem, MD1, Sheena Bhushan, MD2 1Northeast Georgia Medical Center, Gainesville, GA; 2Northeast Georgia Medical Center, Atlanta, GA
Introduction: Campylobacter jejuni is one of the leading causes of bacterial gastroenteritis. Atypical presentations including Guillain Barre syndrome, reactive arthritis, irritable bowel syndrome, intussusception, small bowel obstruction, miscarriages, peritonitis, perforation, and myocarditis have also been reported but are rare. Here the authors report a rare case of campylobacter induced small bowel obstruction.
Case Description/Methods: A 75-year-old male presented with low-grade fever, nausea, vomiting, abdominal pain, and profuse, watery, non-bloody diarrhea. He denied any sick contacts, recent travels, eating out, and reported washing raw chicken and produce in his kitchen sink. His past medical history was notable for peptic ulcer disease for which he was on daily pantoprazole. At the time of presentation vitals, physical exam, and initial labs were unremarkable. A CT scan of the abdomen and pelvis revealed small bowel distention involving the distal jejunum and throughout the ileum and diffuse abnormality of the colon suspicious for colitis. The following day the patient developed worsening abdominal distention, constipation with an inability to pass flatus. On examination abdomen was diffusely tender and firm on palpation. A repeat CT scan of the abdomen showed large and small bowel distention with the small bowel loops measuring up to 4 cm with air fluid level consistent with partial small bowel obstruction. He was subsequently made NPO, and a nasogastric tube was placed for initial management. Subsequent small bowel series showed persistent opacification small bowel loops suggestive of persistent high-grade distal small bowel obstruction. Meanwhile, the stool studies returned positive for Campylobacter and patient was started on IV Azithromycin. Patient continued to worsen and underwent exploratory laparotomy that revealed a clear transition point at the terminal ileum just proximal to the ileocecal junction, which was decompressed.
Discussion: Campylobacter is widely prevalent in poultry, and once infected, campylobacter colonization of the intestinal tract can persist until they are slaughtered.Therefore, washing of poultry in kitchen sinks should be discouraged. Common risk factors for developing campylobacter infection include recent international travel and use of H2-receptor antagonists and proton pump inhibitors. Most cases are self-limiting and treated with Azithromycin. However, about 20% of GBS cases require intensive care with fatalities as high as 10%.
Figure: Small bowel series showing intestinal obstruction
Franklin Fontem indicated no relevant financial relationships.
Sheena Bhushan indicated no relevant financial relationships.
Franklin Fontem, MD1, Sheena Bhushan, MD2. P4133 - A Rare Case of Small Bowel Obstruction Caused by Campylobacter jejuni, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.