Transcripts
DR. TARR:
Acutely, we see vomiting; small
bowel symptoms consisting of non-bloody diarrhea;
and bloody diarrhea which suggests a colonic
abnormality in the gastrointestinal tract.
The right lower quadrant, in the
region of the appendix, is often quite inflamed in
such children. And my colleagues in radiology
who perform abdominal ultrasounds frequently see
parts of the small bowel surrounding the appendix
being quite swollen.
And it's also not uncommon for
a surgeon to be consulted in the work-up of such
a child and sometimes it's appropriate to perform
a very quick exploratory abdominal operation.
One can see appendicitis in the
setting of an acute E. coli infection and it
would be tragic to overlook such a treatable
disease. It is much better to have a very
brief operation to make certain that there's
nothing in the abdomen that's surgically
remediable, even if you have a pretty good idea
that you're dealing with E. coli infection.
In the colon the symptoms
consist chiefly of the bloody diarrhea, which
occurs 80 to 90 percent of the time in children
who have acute E. coli 0157:H7 infection.
Rectal prolapse can also be a
sign of E. coli 0157:H7 infections. Also one
can see intussusception where the colon
telescopes upon itself, a complication that can
frequently be reduced with an air enema with
the radiologist's participation. On rare occasions it
will require an operation to reduce, in which
case this too would be another indication for a
surgical procedure.
In any case, it's very valuable
to have an experienced pediatric surgeon
assessing such a child because the pain is
intense, as you're quite aware and a
well-considered thought process is often necessary
to decide what should be done.
