cefotaxime and Crohn-Disease

The effects of perioperative antibiotic prophylaxis in elective colon surgery was evaluated in a prospective study on 100 patients. Bowel cleansing was done by orthograde lavage. The patients were divided into 5 groups receiving equally cefotaxime 3 x 2 g, lamoxactam 3 x 2 g, cefmenoxime 3 x 1 g, mezlocillin 3 x 5 g an piperacillin 3 x 4 g. Mucosa biopsies of the resected colon were taken for aerobic and anaerobic cultures. Further mucosal serum probes were frozen immediately for determination of tissue and serum levels of the antibiotics. Our results show that bacterial growth of the colon mucosa was significantly reduced. Anaerobes were identified in only 8%. The tissue concentrations exceeded the MIC-levels of the identified bowel organisms many times over. The clinical infection rate was 4%. All administered antibiotics can be recommended without reservation.

Topics: Aged; Anti-Bacterial Agents; Cefmenoxime; Cefotaxime; Colonic Neoplasms; Combined Modality Therapy; Crohn Disease; Diverticulitis, Colonic; Humans; Intestinal Mucosa; Mezlocillin; Middle Aged; Moxalactam; Piperacillin; Premedication; Rectal Neoplasms; Surgical Wound Infection

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Crohn Disease; Humans; Infliximab; Liver Abscess; Male; Remission Induction

Crohn disease is a chronic inflammatory disease characterized by sharply demarcated segments of gastrointestinal involvement from mouth to anus. Its perineal manifestations are among the most devastating and mutilating complications. They occur at any time and may precede the intestinal manifestations. Their most common presentations are perineal ulceration, fistula, and abscess. Proliferative and polypoid morphology of the cutaneous lesions mimicking warts and condyloma are rarely described. We report a 25-year-old woman with a 4-month history of confluent plaques of the perineal region with vegetant surfaces, suspected to be genital warts. The lesions progressed to fistulas, inducing deep ulcerations surrounded by pseudocondylomatous tumors. About 2 months prior to presentation she began to suffer from gastrointestinal symptoms and noted weight loss. Physical examination, endoscopic examination, and pathological interpretation led to the diagnosis of Crohn disease with perineal involvement being the initial presenting sign. Significant improvement was induced with prednisone (45 mg daily) and azathioprine. Our observation is notable for the pseudocondylomatous appearance and the dramatic response to medical treatment despite severe involvement.

Topics: Adult; Anti-Bacterial Agents; Azathioprine; Cefotaxime; Crohn Disease; Female; Humans; Immunosuppressive Agents; Metronidazole; Perineum; Prednisone; Rectovaginal Fistula

A 30-year-old male was transferred to the intensive care unit with worsening sepsis of unknown origin and a known history of Crohn's disease. The patient presented with a five-day history of nausea, fever, and serous diarrhea. Clinical examination of the abdomen was unremarkable except for mild epigastric pain on palpation.. Computed tomography (CT) of the abdomen revealed gas within the intrahepatic branches of the portal venous system, thickening of the wall of the neoterminal ileum, and mild ascites. In addition, ultrasonography showed acute thrombosis of the portal vein and the superior mesenteric vein. No wall perfusion was seen in either the neoterminal ileum or the ascending colon on color Doppler sonography.. Based on the combination of portal vein thrombosis along with venous gas in the portal venous system and absence of intestinal perfusion, the diagnosis of pylephlebitis with septic shock was suspected and a laparotomy was performed. Intraoperative exploration revealed phlegmonous terminal ileitis, a significant amount of cloudy fluid, and thrombosis of the mesenteric vein. A right-sided hemicolectomy with ileotransversostomy was performed. Histologic examination confirmed Crohn's disease that was associated with vasculitis and, in particular, with thrombophlebitis and subsequent transmural bowel necrosis. Antibiotic and anticoagulation therapy was resumed without further complications.. In the differential diagnosis of sepsis, especially in combination with abdominal pain or gas in the portal venous system, pylephlebitis should be taken into account. Because of the high mortality, immediate further diagnostic testing and appropriate therapy of this rare diagnosis are necessary.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anticoagulants; Cefotaxime; Crohn Disease; Diagnosis, Differential; Embolism, Air; Heparin; Humans; Male; Mesenteric Veins; Metronidazole; Phlebitis; Portal Vein; Radiography; Shock, Septic; Thrombosis; Ultrasonography