gms | German Medical Science

Background: The incidence of invasive aspergillosis in children is increasing according to intensive treatment, immunosuppression and extended use of broad-spectrum antibiotics.

Results: We report a 3-year old boy with acute lymphoblastic leukemia presenting with signs of paralytic ileus. The patient had an increasing index of serum aspergillus antigen of unknown etiology. Abdominal CT scan showed a conglomerate of dilatated small intestine behind the stomach. He underwent explorative laparotomy and we found multiple intestinal perforations and covered ulcerations in proximal jejunum and performed partial jejunal resection with primary end-to-end-anastomosis. He empirically received antifungal therapy with amphotericin B and voriconazol. While microbiologic cultures remained negative, calcoflor staining of intraoperative specimen revealed septate hyphae suspicious for Aspergillus species. PCR confirmed the diagnosis of intestinal aspergillosis. Postoperative wound healing was without complications. He developed severe pulmonary insufficiency and esophageal stenosis because of disseminated invasive aspergillosis and was treated with mechanical esophageal dilatations. Now, one year after undergoing laparotomy the patient is without major intestinal problems and chemotherapy protocol is successfully continued.

Conclusion: Surgeons should be aware of surgical complications of intestinal aspergillosis in children, which are a rare event and still difficult to diagnose due to unspecific abdominal symptoms.

Figure 1 [Fig. 1]