Phlegmonous colitis: a specific and severe complication of chronic hepatic disease

Abstract

Phlegmonous colitis (PC) is an acute infectious entity caused by bacteria. In this study, we reviewed 8,822 autopsy cases and found 13 cases of PC (0.15%). PC affected 2.43% of patients with hepatic cirrhosis or subacute liver atrophy, both of which were considered to be due to hepatitis viral infection. Before autopsy, none of the cases studied was suspected to involve PC, irrespective of the immediate cause of patient death. Thirteen autopsy cases showed some or all of the following pathohistologic characteristics: (1) involvement of the cecum (9 cases, 76.9%), (2) phlegmonous inflammatory changes and edema in the submucosa (100%), (3) bacterial infection (100%), (4) no microscopically detectable mucosal injuries (12 cases, 92.3%), and (5) acute serositis (peritonitis) (2 cases, 15.4%). These results suggest that PC is an unrecognized, but fatal complication of patients with some hepatic diseases and that PC has pathohistologic characteristics in common with previously reported spontaneous bacterial peritonitis in animal models. PC probably arises due to spontaneous infection in patients with hepatic cirrhosis.

Vibrio vulnificus infection in patients with liver disease: report of five autopsy cases

“…The small intestine seemed to be the main portal of V. vulnificus invasion since intestinal mucosal injury, including edema, hemorrhagic necrosis, and lymphocyte infiltration, was evident in four cases. In addition, the HIV-infected patient showed phlegmonous colitis, a rare but fatal complication in patients with hepatic disease [15], without evidence of mucosal injury. Differences between the patients may be due to different mechanisms of bacterial infection.…”

“…Differences between the patients may be due to different mechanisms of bacterial infection. Bacterial translocation from the intestinal lumen to the submucosa with microscopically undetectable mucosal injury is considered to be the pathogenesis of phlegmonous colitis [6,10,15]. Although Escherichia coli is the most commonly reported causative agent for phlegmonous colitis, V. vulnificus in the gastrointestinal tract may gain entry into the submucosa by bacterial translocation.…”

“…Patients with hepatic cirrhosis are known to be susceptible to bacterial infection [4,15,19,20]. Frequent isolation of enteric organisms suggests that the gastrointestinal tract is an important source of infection [7,9,12,20].…”

Phlegmonous gastritis in a patient with rheumatoid arthritis

“…An examination of the abdominal cavity using computerized tomography (abdominal CT) can clarify the clinical picture better than plain film radiography of the abdomen [26,27]. The inflammatory process may be limited to the gastric mucosa or it may spread along the digestive tube into the esophagus -phlegmonous esophagitis, or the sigmoid part of the large intestine -phlegmonous enterocolitis [3,15,21,22,[26][27][28][29]. An inflammation in the gastric wall, most strongly affecting the submucosa, can be either diffusely phlegmonous or abscedent (due to the development of granulation tissue and, subsequently, abscesses -the abscedent form of PG [30]).…”

Phlegmonous colitis: another source of sepsis in cirrhotic patients?

“…In 2009, PC remains almost exclusively an autopsy finding, and was actually detected post-mortem in 2.5% of patients with cirrhosis: thirteen autopsy cases showed some or all of the following clinico-pathologic characteristics: (1) preferential involvement of the cecum; (2) phlegmonous changes in the submucosa; and (3) bacterial infection [6,7]. These results suggest that PC is a severe and specific complication of portal hypertension.…”