An Occurrence of Sepsis During Inpatient Fecal Disimpaction

Abstract

Functional constipation is a common pediatric problem that is often treated through well-established algorithms. Fecal disimpaction is the initial therapeutic step, and severe cases require hospitalization for intensive therapies. We describe a significant unexpected complication of this common clinical situation. An 8-year-old boy with suspected chronic functional constipation was hospitalized for disimpaction by continuous nasogastric administration of polyethylene glycol electrolyte (PEG-E) solution. On the sixth day of disimpaction, the patient abruptly developed fever, tachycardia, and tachypnea. Evaluation included blood culture, which grew Escherichia coli, and treatment with a course of appropriate antibiotics was provided. The safety of PEG-E solutions has been shown in studies of children with constipation, which made this patient’s illness surprising. Several potential etiologies of his infection were considered, including bacterial translocation (BT). BT is defined as the passage of live microbes and microbial products from the gastrointestinal tract to extraintestinal sites, such as the bloodstream. It has been shown to occur in a variety of clinical conditions but is of unclear clinical significance. In this case, physical damage to the intestinal mucosa was thought to contribute to the potential occurrence of BT, and prolonged disimpaction was considered as a risk factor. E coli sepsis in a child undergoing inpatient nasogastric fecal disimpaction with PEG-E represents a clinical problem never before reported in the literature and should increase clinicians’ indices of suspicion for uncommon complications of common procedures.

Citrobacter braakii bacteremia-induced septic shock after colonoscopy preparation with polyethylene glycol in a critically ill patient: a case report

“…It was speculated that bacterial translocation might have occurred after the patient ingested PEG. Darrow et al reported an 8-year-old boy who suffered E. coli bacteremia during the treatment of functional constipation via PEG-based fecal disimpaction [3]. They concluded that physical damage to the intestinal mucosa had contributed to the occurrence of bacterial translocation.…”

“…Only two cases of bacteremia after PEG ingestion have been reported, which were supposed to have been caused by bacterial translocation [2, 3]. Although Citrobacter spp.…”

Serum Endotoxin Activity Measured with Endotoxin Activity Assay Is Associated with Serum Interleukin-6 Levels in Patients on Chronic Hemodialysis

“…A stercoral injury resulting from chronic fecal impaction could cause intestinal mucosa damage leading to increased permeability [19][20][21] . Although rare, such injuries are typically seen among the elderly, nursing home-dependent, bedridden, or narcotic-dependent patients [19][20][21] .…”

“…A stercoral injury resulting from chronic fecal impaction could cause intestinal mucosa damage leading to increased permeability [19][20][21] . Although rare, such injuries are typically seen among the elderly, nursing home-dependent, bedridden, or narcotic-dependent patients [19][20][21] . Constipation may also affect the bacterial metabolism in the gut [22,23] and increase the contact time between uremic toxins originating from colon and the intestinal epithelium contributing to its damage and to bacterial translocation [24] .…”

Safety and efficacy of a defecation care algorithm based on ultrasonographic bowel observation in Japanese home‐care settings: a single‐case, multiple‐baseline study

“…Several problems, such as diarrhea, are caused by administering unnecessary laxatives and by routine administration of suppositories to patients without rectal fecal retention. Furthermore, digital disimpaction should not be carried out in patients without fecal impaction owing to its invasiveness and risk of rectal mucosal damage . A new objective assessment method is required for nurses to accurately assess constipation to observe fecal retention and evaluate constipation in home‐care settings such that laxative administration is minimized.…”