Image highlight: Lethal pneumatosis coli

Macroscopic, histological and ultrastructural assessment of small intestine tissue: (a) Macroscopic picture of the oedematous intestinal wall with multiple submucosal and subserosal cysts; (b) Histological picture of the intestinal mucosa with areactive necrosis; (c) Gram stain of cysts with large rod-shaped bacteria; (d) Electron microscopic picture of a bacterium found in a submucosal cyst.

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Stephen Kircher et al., University Würzburg, Germany, present the case of a 12-month-old boy who suffered from perinatal asphyxia during delivery, resulting in severe hypoxic encephalopathy with tetraparesis and epilepsy. In addition he suffered from considerable dysphagia from birth. For this reason his parents provided artificial nutrition by a stomach tube at home, consisting of hydrolysed milk formula based on amino acids and a natural thickening agent composed of carob seed flour. The patient had a history of abdominal pain, fever and nausea one week prior to being referred to a paediatric clinic with symptoms of acute abdomen, increasing fever, cyanosis and epileptic seizures.
For the full clinical details of this case of lethal pneumatosis coli caused by acute intestinal gas gangrene, please read download the case report and figures for free here.

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