El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Unspecific colitis due to shigellosis. A 58 year-old female that 22 days ago was hospitalized, due to acute diarrhea with bloody and mucoid feces. Shigellosis is an acute bacterial infection caused by the genus Shigella, that produces an unspecific colitis, affecting preferably the rectosigmoid colon. Bacilar dysentery .

Video Endoscopic Sequence 1 of 7.

Unspecific colitis due to shigellosis.

 A 58 year-old female that 22 days ago was
 hospitalized, due to acute diarrhea with bloody and mucoid
 feces.
 

 Shigellosis is an acute bacterial infection caused by the
 genus Shigella, that produces an unspecific colitis, affecting
 preferably the rectosigmoid colon. "Bacilar dysentery ". 

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Colitis due to Shigellosis. The entire colon was affected.

Video Endoscopic Sequence 2 of 7.

“Colitis due to Shigellosis”.

 The entire colon was affected.

 Causes:

  • Shigella sonnei and Shigella flexneri cause 90% of the cases of shigellosis.
  • S dysenteriae has produced epidemic shigellosis.
Colitis due to Shigellosis. Ascending colon, where we found multiple ulcers of different sizes, edema and exudate. Those macroscopic images are ruling out Crohn´s disease and amebic colitis. Ascending colon, where we found multiple ulcers of different sizes, edema and exudate. Those macroscopic images are ruling out Crohn´s disease and amebic colitis.

Video Endoscopic Sequence 3 of 7.

 Ascending colon, where we found multiple ulcers of
 different sizes, edema and exudate.
 
 Those macroscopic images are ruling out Crohn´s
 disease and amebic colitis.

 Shigellosis is a major diarrheal disease throughout the
 world. Shigellae are lactose nonfermenting, non-motile
 gram-negative rods that are comprised of four subgroups
 that are responsible for bacillary dysentery.
Colitis due to Shigellosis. Pathologically, shigellosis is characterized by an acute diffuse inflammation of the colon with initial hyperemia of the mucosa, followed by edema, hemorrhage, and infiltration with leukocytes and macrophages. This process often extends into the submucosa, causing marked thickening of the intestinal wall. Epithelial necrosis and desquamation with formation of a membrane are followed by sinuous ulceration, originating on the tops of the intestinal folds and often extending deep into the submucosa and occasionally into the muscularis; perforation is rare. Inflammation is not usually uniformly distributed throughout the colon but is most severe in the distal portion from sigmoid colon to anus. The terminal Ileum is occasionally involved. Secondary bacterial infection occurs once ulcerative lesions have developed, and may be important in the subsequent development of a chronic state of the disease. In patients in whom dysentery has been of long duration, adjacent ulcers may be joined by ulcerating channels beneath bridges of hyperplastic mucosa.

Video Endoscopic Sequence 4 of 7.

“Colitis due to Shigellosis”.

 Pathologically, shigellosis is characterized by an acute
 diffuse inflammation of the colon with initial hyperemia of
 the mucosa, followed by edema, hemorrhage, and
 infiltration with leukocytes and macrophages. This process
 often extends into the submucosa, causing marked
 thickening of the intestinal wall. Epithelial necrosis and
 desquamation with formation of a membrane are followed
 by sinuous ulceration, originating on the tops of the
 intestinal folds and often extending deep into the
 submucosa and occasionally into the muscularis;
 perforation is rare. Inflammation is not usually uniformly
 distributed throughout the colon but is most severe in the
 distal portion from sigmoid colon to anus. The terminal
 ileum is occasionally involved. Secondary bacterial infection
 occurs once ulcerative lesions have developed, and may be
 important in the subsequent development of a chronic state
 of the disease. In patients in whom dysentery has been of
 long duration, adjacent ulcers may be joined by ulcerating
 channels beneath bridges of hyperplastic mucosa.
Colitis due to Shigellosis. Several tiny ulcers (aphtas). In chronic bacillary dysentery, there is usually extensive scarring and fibrosis of the colon, indolent ulceration, and a continued subacute or chronic inflammation which periodically becomes acute. There are successive periods of exacerbation and remission, and the disease differs little, both clinically and pathologically, from chronic idiopathic ulcerative colitis. During periods of active disease there may be fever and diarrhea with varying amounts of blood, mucus, and cellular debris in the stools. There is often disturbance of normal motor function with retention in the right colon. Considerable fibrosis of the mucosa and submucosa may complicate such chronically recurrent infections. Mucosal retention cysts may form as the result of incomplete healing, and these cysts may harbor Shigella bacilli which are intermittently discharged by chronic carriers. In severe dysentery caused by the Shiga bacillus, toxic nephritis is a common cause of death and emboli are often seen in The liver and spleen.

Video Endoscopic Sequence 5 of 7.

“Colitis due to Shigellosis”.

 Several tiny ulcers (aphtas).
 In chronic bacillary dysentery, there is usually extensive
 scarring and fibrosis of the colon, indolent ulceration, and a
 continued subacute or chronic inflammation which
 periodically becomes acute. There are successive periods
 of exacerbation and remission, and the disease differs little,
 both clinically and pathologically, from chronic idiopathic
 ulcerative colitis. During periods of active disease there
 may be fever and diarrhea with varying amounts of blood,
 mucus, and cellular debris in the stools. There is often
 disturbance of normal motor function with retention in the
 right colon. Considerable fibrosis of the mucosa and
 submucosa may complicate such chronically recurrent
 infections. Mucosal retention cysts may form as the result
 of incomplete healing, and these cysts may harbor Shigella
 bacilli which are intermittently discharged by chronic
 carriers.
 In severe dysentery caused by the Shiga bacillus, toxic
 nephritis is a common cause of death and emboli are often
 seen in the liver and spleen.
"Colitis due to Shigellosis". Anus and rectum. Findings: Endoscopy reveals friable, hyperemic mucosa that involves that rectum and sigmoid colon in a confluent pattern very similar to ulcerative colitis. Approximately 50 % of patients have involvement to the splenic flexure but it is rare to have ulcerations in the terminal ileum.

Video Endoscopic Sequence 6 of 7.

“Colitis due to Shigellosis”.

 Anus and rectum.

 Findings: Endoscopy reveals friable, hyperemic mucosa
 that involves that rectum and sigmoid colon in a confluent
 pattern very similar to ulcerative colitis. Approximately 50
 % of patients have involvement to the splenic flexure but
 it is rare to have ulcerations in the terminal ileum.

 
"Colitis due to Shigellosis". The rectum and anus in retroflexed image, the image and the video display edema and ulcerations. Humans are the only natural host and the organism primarily affects only the colon. The mode of transmission is fecal-oral and the organisms invade colonocytes but rarely invade the blood stream. There is often a biphasic illness with initial symptoms of fever, abdominal pain, and nonbloody watery diarrhea followed 3 to 5 days later by tenesmus and small volume bloody stools. There is an extensive list of extra intestinal manifestations.

Video Endoscopic Sequence 7 of 7.

“Colitis due to Shigellosis”.

 The rectum and anus in retroflexed image, the image and
 the video display edema and ulcerations.

 Humans are the only natural host and the organism
 primarily affects only the colon. The mode of transmission
 is fecal-oral and the organisms invade colonocytes but
 rarely invade the blood stream. There is often a biphasic
 illness with initial symptoms of fever, abdominal pain, and
 nonbloody watery diarrhea followed 3 to 5 days later by
 tenesmus and small volume bloody stools. There is an
 extensive list of extraintestinal manifestations.

 
Cryptosporidiosis of the Colon. A 65 year-old man with a 6 months diarrhea syndrome infected with HIV. The mucosa of the Sigmoid Colon and rectum presented with hyperplasia and with some clusters of brown maculas. Biopsies showed intestinal cryptosporidiosis. Crystosporidiosis can cause severe chronic and cholera-like diarrhea.

Video Endoscopic Sequence 1 of 3.

Cryptosporidiosis of Colon.

 A 65 year-old man with a 6 month diarrhea syndrome
 infected with HIV.
 The mucosa of the Sigmoid Colon and rectum presented
 with hyperplasia and with some clusters of brown maculas.
 Biopsies showed intestinal cryptosporidiosis.
 Crystosporidiosis can cause severe chronic and
 cholera-like diarrhea.

Click here to see the biopsies.

 
Cryptosporidiosis of the Colon. The rectal mucosa displays some degree of hyperplasia and a cluster of brownish maculas. Cryptosporidium, a protozoan member of the family of coccidia that also includes Pneumocystis carinii and Toxoplasma gondii. Cryptosporidiosis accounts for about 10% of the cases of chronic diarrhea in patients with AIDS.Diarrhea due to Cryptosporidium is being recognized with increasing frequency, both in normal and inmunocompromised patients. In inmunocompetent persons diarrhea is self-limited and characterized by copious amounts of watery stool. Inmunocompromised patients develop chronic watery diarrhea with stool volume often in excess of 3 L.a day. Biliary tract involvement with crytosporidiosis has been described and extra-intestinal infection may be observed in compromised patients.

Video Endoscopic Sequence 2 of 3.

 The rectal mucosa displays some degree of hyperplasia
 and a cluster of brownish maculas. 
 Cryptosporidium, a protozoan member of the family of
 coccidia that also includes Pneumocystis carinii and
 Toxoplasma gondii. Cryptosporidiosis accounts for
 about 10% of the cases of chronic diarrhea in patients
 with AIDS.
 Diarrhea due to Cryptosporidium is being recognized
 with increasing frequency, both in normal and
 inmunocompromised patients. In inmunocompetent
 persons diarrhea is self-limited and characterized by
 copious amounts of watery stool. Inmunocompromised
 patients develop chronic watery diarrhea with stool
 volume often in excess of 3 L.a day.
 Biliary tract involvement with crytosporidiosis has been
 described and extra-intestinal infection may be
 observed in compromised patients.
Cryptosporidiosis of the Colon, Close up image with zoom. The mucosa has a mosaic pattern. Endoscopic features of cryptosporidiosis of the colon. The involved mucosa may be reddened and may be covered with a mucoid exudate. The major histologic findings in the small intestine are parcial villus atrophy and crypt hyperplasia, associated with marked acute and chronic inflammation. The lesions are diffuse in the small intestine and cause a spruelike patterns on a barium x-ray enema. In the colon, crypt epithelial cell damage associated with cryptosporidiosis may be seen focally or diffusely. Cryptosporidium infections have been described to infect the epithelium in every portion of the gastrointestinal tract from the pharynx to the rectum.

Video Endoscopic Sequence 3 of 3.

Close up image with zoom.

The mucosa has a mosaic pattern.

 Endoscopic features of cryptosporidiosis of the colon.
 The involved mucosa may be reddened and may be
 covered with a mucoid exudate. The major histologic
 findings in the small intestine are parcial villus atrophy
 and crypt hyperplasia, associated with marked acute and
 chronic inflammation. The lesions are diffuse in the small
 intestine and cause a spruelike patterns on a barium
 x-ray enema.
 In the colon, crypt epithelial cell damage associated with
 cryptosporidiosis may be seen focally or diffusely.
 Cryptosporidium infections have been described to infect
 the epithelium in every portion of the gastrointestinal tract
 from the pharynx to the rectum.