ABSTRACT
A previously well 5-year-old male presents with an acute abdomen and severe septic shock after 5 days of diarrhea and vomiting. At laparotomy, total colonic necrosis is found, extending up to the peritoneal reflection. Traditional hot-water enema administration is denied by caregivers but is suspected by the clinicians. After a damage control laparotomy at which a total colectomy is done with ligation of the terminal ileum and the abdomen is closed with a Bogota bag, an end-ileostomy is created at a relook laparotomy 48 hours later. The rectum is necrotic to the dentate line at the time of relook laparotomy. Histology of the resected necrotic bowel demonstrates ganglionated bowel, and an infectious agent is not identified. (Serological tests for Salmonella typhi and stool samples for Campylobacter, Yersinia, Shigella, hemorrhagic Escherichia coli, and amoebiasis are negative.)
