Salmonella typhi Gastroenteritis as a Rare Cause of Small Bowel Obstruction: 2620

INTRODUCTION: Salmonella gastroenteritis is a common foodborne illness that presents with diarrhea, nausea, vomiting, and abdominal cramps or constipation after 6 to 72-hour incubation period, and resolves in 4–10 days. Small bowel obstruction (SBO) as a result of acute bacterial infection however is extremely rare. Here we report a case of SBO caused by Salmonella typhimurium , a rare clinical manifestation of the infection that has not been reported. In this case, we discuss how successful diagnosis and subsequent antibiotic therapy led to resolution of the small bowel obstruction. CASE DESCRIPTION/METHODS: A 72-year-old male with a history of remote testicular cancer, recent lung cancer pending resection, presented to the emergency department (ED) with fatigue, abdominal distention, vomiting and non-bloody diarrhea for 1 week. He reported having a new jalapeno artichoke dip a few days prior. No recent travel or prior abdominal surgery. In ED, vitals: BP 81/52, HR 117, RR 32, T 98.6. Exam showed abdominal distention with lower quadrant and rebound tenderness. Labs showed WBC 4 × 10 9 /L (43% bands), lactic acid 7.3 mmol/L, and negative C. difficile. CT Abdomen showed significant small bowel dilation with abnormal thickening noted in the distal ileum; consistent with small bowel obstruction. He was admitted to ICU for sepsis likely secondary to SBO. IV fluids led to hemodynamic improvement, and conservative treatment with nasogastric tube and bowel rest were initiated. Serial X-rays showed persistent dilated bowel loops. Stool cultures returned day 4 for S. typhimurium , and ciprofloxacin was started with clinical improvement in 2 days. By day 7, X-ray showed resolution of dilated small bowel. Patient was transitioned to an oral diet and discharged in stable condition by day 9. DISCUSSION: Progression to SBO from Salmonella as in our patient, to the best of our knowledge has never been reported. Salmonella as a causal agent for enteritis or other complications can be extremely difficult to diagnose if not suspected. Terminal ileitis on CT can lead to mimicking of other diseases such as Crohn’s, however an infectious etiology should remain on the differential, even in the setting of SBO. Although definitive diagnosis is based on culture, CT findings of circumferential and homogenous thickening of the terminal ileum in the appropriate clinical context can also help facilitate timely initiation of antibiotics and avoid possible aggressive interventions including surgery