Abdominal distension in the Maldivian Shigella epidemic (1982) - an ominous sign

Abstract

Progressive abdominal distension had preceeded death in 12 cases during the early part of the Maldivian Shigella Epidemic (April-June 1982). A prospective clinical study 172 adult patients admitted with Bacillary dysentery (caused by Shigella dysenteriae type 1) was over a one week period in June 1982. Twenty patients had at presentation abdominal distension (15 mild, 3 moderate and 2 severe) and it was found to be progressive. There was no clinical, biochemical or Electro cardiographic evidence to suggest hypokalaemia as the cause for distension. X' ray abdomen showed colonic distension. On the assumption that agas producing anaerobe may be responsible metronidazole oral (in mild cases) and I.V (in moderate and severe cases) was added to the existing regimen of parenteral antibiotics, nil by month, flatus tube and I.V fluids. Stools examination failed to reveal Entamoeba histolytica. We found that in 18 cases (15 mild and 3 moderated), the progressive distension reversed and peristalsis returned within 24-48 hrs of staring Metronidazole. The patients felt better following 1 or 2 foul smelling motions. The two patients with severe abdominal distension died despite measures mentioned above. Difficulty in passing urine and pelvic pain was complained of in association with abdominal distension (particularly in the moderate and severe cases) and this triad of symptoms was found to be associated with poor prognosis. From our observations we suggest; I. Notice be taken of abdominal distension, difficulty in passing urine and pelvic pain in Shigellosis. 2. Further studies using Anaerobic stool cultures be done to evaluate the aetiology of the abdominal distension. 3. Early introduction of oral or I.V. Metronidazole in cases with moderate or severe distension is suggested based on our clinical observation.