Phlegmonous colitis: a specific and severe complication of chronic hepaticdisease

Phlegmonous colitis (PC) is an acute infectious entity caused by bacteria. In this study, we reviewed 8822 autopsy cases and found 13 cases of PC (0.1 5%). PC affected 2.43% of patients with hepatic cirrhosis or subacute liver atrophy, both of which were considered to be due to hepatitis viral infect ion. Before autopsy, none of the cases studied was suspected to involve PC, irrespective of the immediate cause of patient death. Thirteen autopsy cas es showed some or all of the following pathohistologic characteristics: (1) involvement of the cecum (9 cases, 76.9%), (2) phlegmonous inflammatory ch anges and edema in the submucosa (100%), (3) bacterial infection (100%), (4 ) no microscopically detectable mucosal injuries (12 cases, 92.3%), and (5) acute serositis (peritonitis) (2 cases, 15.4%). These results suggest that PC is an unrecognized, but fatal complication of patients with some hepati c diseases and that PC has pathohistologic characteristics in common with p reviously reported spontaneous bacterial peritonitis in animal models. PC p robably arises due to spontaneous infection in patients with hepatic cirrho sis.