Clinical Images

Thumbprinting of Bowel

Presentation:

A previously healthy 20-year-old woman developed an acute gastroenteritis 3 weeks prior to admission, having fever, abdominal pain and up to ten watery, non-bloody bowel movements per day. She was evaluated by her physician, but received no antibiotics. Stool cultures grew Salmonella Saintpaul. She slightly improved over the next two weeks, but subsequently worsened with progressive nausea and vomiting, increasing stool frequency, severe abdominal pain but non-surgical abdomen, and T 102°F and WBC 30,000 cells/ml. HIV test is negative. Twelve hours after admission, she developed a rigid abdomen requiring explorative laparotomy which revealed 1 L of clear peritoneal fluid and marked bowel wall thickening without evidence of perforation. She later became hypotensive, requiring vasopressor support.

This case was published in JGIM 2011 January; 26(1): 95-97 
Authors: Stephanie A.C.Halvorson MD, Andrea S. Cedfeldt MD, Alan J. Hunter, MD 
The full manuscript with the answer is available in public domain on PubMed Central