CR19P A RARE CASE OF MASSIVE GASTROINTESTINAL HAEMORRHAGE: AN IMPORTANT CONSIDERATION IN TRAVELLERS

Abstract

We report a case of massive gastrointestinal haemorrhage in a traveller who presented to a tertiary hospital emergency department in Melbourne, Australia. An 18 year‐old man from India presented with two weeks of malaise, anorexia, fever and generalised abdominal pain and had massive rectal bleeding on presentation. He underwent computed tomography angiography before urgent laparotomy and ileocolic resection of a bleeding ulcer in the terminal ileum. Blood cultures subsequently grew Salmonella typhi. Histopathology showed multiple areas of ulceration centred on Peyer's patches, transmural mononuclear cell infiltrates and focal non‐necrotizing granulomas. A diagnosis of enteric fever causing massive bleeding from an ulcer in the terminal ileum was made and the Health Department notified. The patient had four weeks of antibiotic therapy and made a full recovery.Surgery was once thought contraindicated in enteric fever complicated by bleeding, citing a tendency for the bowel to be friable and difficulty locating the site of bleeding in multiple ulcers. Bleeding and perforation occur from necrosis of Peyer's patches. However, evidence shows this is limited to the terminal ileum and proximal colon, allowing directed surgical excision. In the current age of international travel, surgeons must be increasingly aware of relevant diseases that may have had their origins overseas. Enteric fever should be considered in patients with rectal bleeding who are travellers and immigrants from endemic areas with a compatible illness.