Mucormycosis of the colon in a premature neonate

Abstract

A 10-day-old, male baby born to a primigravida of 23year at 36 weeks of gestation via emergency Caesarian section for oligohydramnios, was referred to us for abdominal distension and respiratory distress for 3 days. He had not passed stools for 3 days. He was small for gestational age weighing 1.5 kg and had Apgar scores of 4 and 8 at 1 and 5 minutes and had to be put on continuous positive airway pressure (CPAP) soon after delivery. At presentation, the patient’s general condition was poor was on inotropic support for septicemic shock. The nasogastric tube was in situ draining a significant amount of bilious aspirate. On abdominal examination, the abdomen was distended with generalized tenderness and guarding with absent bowel sounds on auscultation. Preliminary lab investigation results were: TLC=40,000 cells/cumm; Platelets=40,000 cells/cumm; CRP=64mg/L. The patient was intubated and taken on hand ventilation and a bolus of intravenous fluid was given along with broad-spectrum antibiotics. X-ray abdomen showed few dilated gut loops with the paucity of air in the intestine. On abdominal ultrasonography, there was minimal inter-gut free fluid with air and fluid-filled dilated gut loops. After hemodynamic stabilization, the patient was taken up for exploratory laparotomy that showed 15ml of sero-feco-purulent peritoneal fluid and a 5 cm gangrenous and perforated segment of the proximal sigmoid colon with thick meconium/fecal matter in the left iliac fossa. A segment of the proximal ileum was found stuck to the involved sigmoid colon segment leading to kinking and perforation at its apex. Therefore, resection of involved gangrenous sigmoid colon and perforation bearing segment of proximal ileum was done with end-to-end colo-colic and ileo-ileal anastomoses. The histopathological examination showed sigmoid colon had the aggregate of Langhans and foreign body giant cells with areas of necrotic exudates and serositis and the detection of many wide, ribbon-like, sparsely septate fungal hyphae with wide angle branching (approximately 90 degrees) characteristic of mucormycosis without any angioinvasion (Fig. 1). The postoperative period was uneventful and the patient was discharged on the seventh postoperative day after he had started accepting orally and passing flatus and stools normally. He is on regular follow-up, thriving well with a weight appropriate for his age.