Urgent Colectomy for Colonic Necrosis Following Shiga Toxin-Producing Escherichia coli O157 Infection in an Adult.

INTRODUCTION

Shiga toxin-producing Escherichia coli (STEC) O157 infection is usually treated conservatively; surgery is rarely required and mostly reserved for children with hemolytic uremic syndrome (HUS). We report a case of STEC O157 requiring urgent surgery in an adult without HUS.

CASE PRESENTATION: A 73-year-old woman presented with abdominal pain and diarrhea. Abdominal CT showed diffuse wall thickening in the ascending and transverse colon. Infectious enteritis and acute exacerbation of chronic renal failure were diagnosed, and antibiotics and continuous hemodiafiltration were initiated. On day 5 of hospitalization, necrotic ischemic colitis was suspected owing to bloody diarrhea and contrast-enhanced CT findings of wall thinning of the ascending and transverse colon. On laparotomy, the ascending colon and proximal transverse colon were necrotic, and urgent surgery (right hemicolectomy) was performed. Postoperatively, the stool sample provided at admission was found to be positive for Escherichia coli O157 and Shiga toxin.

CONCLUSIONS

The postoperative course was uneventful, and dialysis was discontinued. This case highlights that STEC O157 infection can rapidly progress to life-threatening colonic necrosis in adults without HUS, requiring timely surgical intervention.