Factors associated with intestinal perforation in children's non-typhi Salmonella toxic megacolon

Hsun Chin Chao, Cheng Hsun Chiu, Man Shan Kong, Luan Yin Chang, Yhu Chering Huang, Tzou Yien Lin, Chih Chen Lou

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background. To evaluate the risk factors for intestinal perforation in children with toxic megacolon caused by non-typhi Salmonella infection. Methods. During an 11-year period we reviewed the records of children treated for non-typhi Salmonella infection. All of the subjects had positive stool culture for non-typhi Salmonella and were treated with intravenous ceftriaxone during hospitalization. Clinical data reviewed included demographic features, clinical manifestations, laboratory findings, radiologic findings, microbiology, therapeutic effect of hydration and rectal tube placement and the operative findings. Patients with toxic megacolon were defined as those having toxic appearance, diarrhea, high fever (>39°C) and marked colon dilatation with maximal diameter >1.5 times the width of the vertebra body of the first lumbar spine (L1-VB). To define the risk factors for patients with toxic megacolon complicated by intestinal perforation, patients were divided into two groups for analysis: P group, those complicated with intestinal perforation; and NP group, those without intestinal perforation. Differences in age, sex, severity of diarrhea, duration of fever, hemogram and its differential, culture, stool analysis, serum C-reactive protein (CRP), electrolytes, maximal colon diameter, medical therapy and timing of rectal tube insertion between the two groups were analyzed. Statistical analyses were conducted with chi square tests and multiple logistic regression. Results. A total of 75 patients (P group, 27 patients; NP group, 48 patients) ages 4 months to 6 years were evaluated. With chi square analysis 7 variables were found to be significantly associated with intestinal perforation: age >1 year; fever >5 days; ratio of immature to total neutrophils >20%; serum CRP >200 mg/l; colon diameter >2.5 times the width of L1-VB; inadequate early hydration; and delay in rectal tube insertion. With multivariate analysis age >1 year, serum CRP >200 mg/l and colon diameter >2.5 times of width of L1-VB, inadequate early hydration and delay in rectal tube insertion were the most significant factors associated with intestinal perforation. Conclusion. Identification of patients with toxic megacolon associated with non-typhi Salmonella infection at risk for further intestinal perforation is possible. Early effective fluid resuscitation and rectal tube insertion may be helpful to prevent the occurrence of intestinal perforation.

Original languageEnglish
Pages (from-to)1158-1162
Number of pages5
JournalPediatric Infectious Disease Journal
Volume19
Issue number12
DOIs
Publication statusPublished - 2000
Externally publishedYes

Fingerprint

Toxic Megacolon
Intestinal Perforation
Salmonella
Salmonella Infections
Colon
C-Reactive Protein
Blood Proteins
Fever
Diarrhea
Spine
Ceftriaxone
Poisons
Therapeutic Uses
Chi-Square Distribution
Microbiology
Resuscitation
Electrolytes
Dilatation
Hospitalization
Neutrophils

Keywords

  • Intestinal perforation
  • Non-typhi Salmonella
  • Toxic megacolon

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Factors associated with intestinal perforation in children's non-typhi Salmonella toxic megacolon. / Chao, Hsun Chin; Chiu, Cheng Hsun; Kong, Man Shan; Chang, Luan Yin; Huang, Yhu Chering; Lin, Tzou Yien; Lou, Chih Chen.

In: Pediatric Infectious Disease Journal, Vol. 19, No. 12, 2000, p. 1158-1162.

Research output: Contribution to journalArticle

Chao, Hsun Chin ; Chiu, Cheng Hsun ; Kong, Man Shan ; Chang, Luan Yin ; Huang, Yhu Chering ; Lin, Tzou Yien ; Lou, Chih Chen. / Factors associated with intestinal perforation in children's non-typhi Salmonella toxic megacolon. In: Pediatric Infectious Disease Journal. 2000 ; Vol. 19, No. 12. pp. 1158-1162.
@article{20e64a7d04324cb6b88cde8a78250061,
title = "Factors associated with intestinal perforation in children's non-typhi Salmonella toxic megacolon",
abstract = "Background. To evaluate the risk factors for intestinal perforation in children with toxic megacolon caused by non-typhi Salmonella infection. Methods. During an 11-year period we reviewed the records of children treated for non-typhi Salmonella infection. All of the subjects had positive stool culture for non-typhi Salmonella and were treated with intravenous ceftriaxone during hospitalization. Clinical data reviewed included demographic features, clinical manifestations, laboratory findings, radiologic findings, microbiology, therapeutic effect of hydration and rectal tube placement and the operative findings. Patients with toxic megacolon were defined as those having toxic appearance, diarrhea, high fever (>39°C) and marked colon dilatation with maximal diameter >1.5 times the width of the vertebra body of the first lumbar spine (L1-VB). To define the risk factors for patients with toxic megacolon complicated by intestinal perforation, patients were divided into two groups for analysis: P group, those complicated with intestinal perforation; and NP group, those without intestinal perforation. Differences in age, sex, severity of diarrhea, duration of fever, hemogram and its differential, culture, stool analysis, serum C-reactive protein (CRP), electrolytes, maximal colon diameter, medical therapy and timing of rectal tube insertion between the two groups were analyzed. Statistical analyses were conducted with chi square tests and multiple logistic regression. Results. A total of 75 patients (P group, 27 patients; NP group, 48 patients) ages 4 months to 6 years were evaluated. With chi square analysis 7 variables were found to be significantly associated with intestinal perforation: age >1 year; fever >5 days; ratio of immature to total neutrophils >20{\%}; serum CRP >200 mg/l; colon diameter >2.5 times the width of L1-VB; inadequate early hydration; and delay in rectal tube insertion. With multivariate analysis age >1 year, serum CRP >200 mg/l and colon diameter >2.5 times of width of L1-VB, inadequate early hydration and delay in rectal tube insertion were the most significant factors associated with intestinal perforation. Conclusion. Identification of patients with toxic megacolon associated with non-typhi Salmonella infection at risk for further intestinal perforation is possible. Early effective fluid resuscitation and rectal tube insertion may be helpful to prevent the occurrence of intestinal perforation.",
keywords = "Intestinal perforation, Non-typhi Salmonella, Toxic megacolon",
author = "Chao, {Hsun Chin} and Chiu, {Cheng Hsun} and Kong, {Man Shan} and Chang, {Luan Yin} and Huang, {Yhu Chering} and Lin, {Tzou Yien} and Lou, {Chih Chen}",
year = "2000",
doi = "10.1097/00006454-200012000-00008",
language = "English",
volume = "19",
pages = "1158--1162",
journal = "Pediatric Infectious Disease Journal",
issn = "0891-3668",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Factors associated with intestinal perforation in children's non-typhi Salmonella toxic megacolon

AU - Chao, Hsun Chin

AU - Chiu, Cheng Hsun

AU - Kong, Man Shan

AU - Chang, Luan Yin

AU - Huang, Yhu Chering

AU - Lin, Tzou Yien

AU - Lou, Chih Chen

PY - 2000

Y1 - 2000

N2 - Background. To evaluate the risk factors for intestinal perforation in children with toxic megacolon caused by non-typhi Salmonella infection. Methods. During an 11-year period we reviewed the records of children treated for non-typhi Salmonella infection. All of the subjects had positive stool culture for non-typhi Salmonella and were treated with intravenous ceftriaxone during hospitalization. Clinical data reviewed included demographic features, clinical manifestations, laboratory findings, radiologic findings, microbiology, therapeutic effect of hydration and rectal tube placement and the operative findings. Patients with toxic megacolon were defined as those having toxic appearance, diarrhea, high fever (>39°C) and marked colon dilatation with maximal diameter >1.5 times the width of the vertebra body of the first lumbar spine (L1-VB). To define the risk factors for patients with toxic megacolon complicated by intestinal perforation, patients were divided into two groups for analysis: P group, those complicated with intestinal perforation; and NP group, those without intestinal perforation. Differences in age, sex, severity of diarrhea, duration of fever, hemogram and its differential, culture, stool analysis, serum C-reactive protein (CRP), electrolytes, maximal colon diameter, medical therapy and timing of rectal tube insertion between the two groups were analyzed. Statistical analyses were conducted with chi square tests and multiple logistic regression. Results. A total of 75 patients (P group, 27 patients; NP group, 48 patients) ages 4 months to 6 years were evaluated. With chi square analysis 7 variables were found to be significantly associated with intestinal perforation: age >1 year; fever >5 days; ratio of immature to total neutrophils >20%; serum CRP >200 mg/l; colon diameter >2.5 times the width of L1-VB; inadequate early hydration; and delay in rectal tube insertion. With multivariate analysis age >1 year, serum CRP >200 mg/l and colon diameter >2.5 times of width of L1-VB, inadequate early hydration and delay in rectal tube insertion were the most significant factors associated with intestinal perforation. Conclusion. Identification of patients with toxic megacolon associated with non-typhi Salmonella infection at risk for further intestinal perforation is possible. Early effective fluid resuscitation and rectal tube insertion may be helpful to prevent the occurrence of intestinal perforation.

AB - Background. To evaluate the risk factors for intestinal perforation in children with toxic megacolon caused by non-typhi Salmonella infection. Methods. During an 11-year period we reviewed the records of children treated for non-typhi Salmonella infection. All of the subjects had positive stool culture for non-typhi Salmonella and were treated with intravenous ceftriaxone during hospitalization. Clinical data reviewed included demographic features, clinical manifestations, laboratory findings, radiologic findings, microbiology, therapeutic effect of hydration and rectal tube placement and the operative findings. Patients with toxic megacolon were defined as those having toxic appearance, diarrhea, high fever (>39°C) and marked colon dilatation with maximal diameter >1.5 times the width of the vertebra body of the first lumbar spine (L1-VB). To define the risk factors for patients with toxic megacolon complicated by intestinal perforation, patients were divided into two groups for analysis: P group, those complicated with intestinal perforation; and NP group, those without intestinal perforation. Differences in age, sex, severity of diarrhea, duration of fever, hemogram and its differential, culture, stool analysis, serum C-reactive protein (CRP), electrolytes, maximal colon diameter, medical therapy and timing of rectal tube insertion between the two groups were analyzed. Statistical analyses were conducted with chi square tests and multiple logistic regression. Results. A total of 75 patients (P group, 27 patients; NP group, 48 patients) ages 4 months to 6 years were evaluated. With chi square analysis 7 variables were found to be significantly associated with intestinal perforation: age >1 year; fever >5 days; ratio of immature to total neutrophils >20%; serum CRP >200 mg/l; colon diameter >2.5 times the width of L1-VB; inadequate early hydration; and delay in rectal tube insertion. With multivariate analysis age >1 year, serum CRP >200 mg/l and colon diameter >2.5 times of width of L1-VB, inadequate early hydration and delay in rectal tube insertion were the most significant factors associated with intestinal perforation. Conclusion. Identification of patients with toxic megacolon associated with non-typhi Salmonella infection at risk for further intestinal perforation is possible. Early effective fluid resuscitation and rectal tube insertion may be helpful to prevent the occurrence of intestinal perforation.

KW - Intestinal perforation

KW - Non-typhi Salmonella

KW - Toxic megacolon

UR - http://www.scopus.com/inward/record.url?scp=0034530907&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034530907&partnerID=8YFLogxK

U2 - 10.1097/00006454-200012000-00008

DO - 10.1097/00006454-200012000-00008

M3 - Article

C2 - 11144376

AN - SCOPUS:0034530907

VL - 19

SP - 1158

EP - 1162

JO - Pediatric Infectious Disease Journal

JF - Pediatric Infectious Disease Journal

SN - 0891-3668

IS - 12

ER -