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World J Gastrointest Surg. Feb 27, 2010; 2(2): 47-50
Published online Feb 27, 2010. doi: 10.4240/wjgs.v2.i2.47
Published online Feb 27, 2010. doi: 10.4240/wjgs.v2.i2.47
Massive small bowel bleeding caused by scrub typhus in Korea
Ki Beom Bae, Won Hwa Youn, Kwan Hee Hong, Department of Surgery, Inje University College of Medicine, Busan Paik Hospital, 633-165 Gaegum-dong, Jin-gu, Busan 614-735, South Korea
Youn Jae Lee, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, 633-165 Gaegum-dong, Jin-gu, Busan 614-735, South Korea
Soo Jin Jung, Department of Pathology, Inje University College of Medicine, Busan Paik Hospital, 633-165 Gaegum-dong, Jin-gu, Busan 614-735, South Korea
Author contributions: Hong KH organized the study and operated on this case; Bae KB assisted with the operation and wrote the manuscript; Youn WH assisted with the operation and conducted the literature review; Lee YJ diagnosed this case and evaluated the patient preoperatively; Jung SJ confirmed the diagnosis by pathologic findings, and all authors approved the final manuscript.
Supported by A grant from Inje University, 2008
Correspondence to: Kwan Hee Hong, MD, PhD, Department of Surgery, Inje University College of Medicine, Busan Paik Hospital, 633-165 Gaegum-dong, Jin-gu, Busan 614-735, South Korea. gskhh@inje.ac.kr
Telephone: +82-51-8906347 Fax: +82-51-8989427
Received: September 22, 2009
Revised: November 4, 2009
Accepted: November 11, 2009
Published online: February 27, 2010
Revised: November 4, 2009
Accepted: November 11, 2009
Published online: February 27, 2010
Abstract
A 79-year-old man was diagnosed with scrub typhus based on fever, eschar, skin rash and a markedly elevated serum tsutsugamushi antibody and doxycycline was started. Five days later, hematochezia developed and multiple small bowel ulcerations with hemorrhage were seen on colonoscopy. Despite intensive therapy, the massive hematochezia worsened and the distal small bowel was resected. Multiple ulcerated lesions were identified pathologically as vasculitis caused by scrub typhus. This is the first reported case of pathologically proven small bowel involvement in scrub typhus infection.
Keywords: Hematochezia, Small bowel bleeding, Scrub typhus, Vasculitis, Multiple small bowel ulcerations