Diagnosis
A necrotizing disease where colonic organisms work together to invade the colon wall like a mixed synergistic necrotizing gangrene. Especially affects the cecum; presents with RLQ pain and increasing cecal size, sometimes with air in the lumen of the colon. When cecum is greater than 10 cm, time to panic (but with grace and style. You are, after all, a doctor).
Epidemiologic Risks
Some chemotherapy agents may predispose to disease (PubMed).
Microbiology
Mixed/colonic flora, streptococci PLUS anaerobes PLUS coliforms.
Empiric Therapy
Surgery is the primary treatment, for antibiotics third-generation cephalosporins PLUS metronidazole OR carbapenems OR quinolone PLUS metronidazole OR penicillin/beta-lactamase inhibitors ALL SELECTIONS +/- aminoglycosides if septic.
Pearls
Evidently is a problem in low land gorillas (PubMed).
Rants
For some odd reason, surgeons do not like to operate on septic patients with no white cells and platelets. Go figure. Mortality rates are high no matter what you do.
Curious Cases
Relevant links to my Medscape blog
Last Update: 03/13/19.