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Ulcerative colitis complicating pregnancy and the puerperium
946
AMERICAN
JOURNAL
OF OBSTETRICS AND GYNECOLOGY
DR. CHARLES S. BARNES AND DR. HELEN AI. HAYES presented a paper entitled Ulcerative Colitis Complicating Pregnancy and the Puerptium. (For original article see page 907.) DISCUSSION DR. FRANK W. KONZELMAN (by invitation).-From the standpoint of the pathologist, the etiology of this condition is of the utmost interest. It is easy to understand that colitis in pregnancy may be divided into two main groups; first, the toxic group, including eclampsia, uremia and eases of chemical poisoning. It is well known that in uremia the mueosa of the colon is frequently damaged, presumably in its effort to excrete the toxins normally excreted by the kidney. In either of the above-named conditions, after toxic injury, the intestinal mucosa may be attacked by the organisms normally found in the lumen, and because they are recovered from smears or cultures from the feces, it is often incorrectly assumed that these organisms are the prime etiologic factors. Second, the parasitic group, including amebic colitis and bacillary dysentery, typhoid fever and other acute and chronic infections, such as pyemia. Ordinarily, the first two present no difficulties in diagnosis. With acute infections such as pyemia, as seen in puerperal sepsis, the streptococcus often is directly responsible for the intestinal lesion. Among the chronic infections, which are by far the most interesting, we find a variety of organisms. Bargen has described a streptococcus morphologically similar to the enterococcus but differing in its serologic reactions. The enterococcus itself is occasionally found. Some observers have found an organism resembling pneumococcus. In the cases cited, the first and fourth undoubtedly fall into this last group. The first case gave a uremic history and closely resembled one of our cases at Temple University. In the latter, an elongated encapsulated streptococcus was found in the intestinal mucosa which resembled, at least morphologically, the one described by Bargen. From the facts presented, one is justified in assuming that there occur in pregnancy cases of colitis in which a definite organism is demonstrable, and that this organism is an elongated, encapsulated diplococcus. Whether it represents a single type or whether there are many varieties of organisms presenting this peculiar morphology, is yet to be learned. Certainly, all cases of colitis occurring in pregnancy should be studied bacteriologically either by making cultures of the stools, or when possible, by direct smears from the mucosa of the lower bowel, and careful cultural phenomena, as well as serologic reactions, should be determined with the organism in each case.
CHICAGO STATED
GYNECOLOGICAL MEETING,
DECEMBER
SOCIETY 19, 1990
DR. JAMES B, HERRICK presented a Memorial Tribute to the Late Dr. Charles E. Paddock, a member of the Society. DR. ALEXANDER G. GABRIELIANZ presented a paper on Spinal An&the.
sia in Gynecology. DR. J. P. GREENHILL
described Rupture
traabdominal Hemorrhage (See page 902.)
of a Corpus Luteum With Inand presented a Report of Three Cues.
AMERICAN
JOURNAL
OF OBSTETRICS AND GYNECOLOGY
DR. CHARLES S. BARNES AND DR. HELEN AI. HAYES presented a paper entitled Ulcerative Colitis Complicating Pregnancy and the Puerptium. (For original article see page 907.) DISCUSSION DR. FRANK W. KONZELMAN (by invitation).-From the standpoint of the pathologist, the etiology of this condition is of the utmost interest. It is easy to understand that colitis in pregnancy may be divided into two main groups; first, the toxic group, including eclampsia, uremia and eases of chemical poisoning. It is well known that in uremia the mueosa of the colon is frequently damaged, presumably in its effort to excrete the toxins normally excreted by the kidney. In either of the above-named conditions, after toxic injury, the intestinal mucosa may be attacked by the organisms normally found in the lumen, and because they are recovered from smears or cultures from the feces, it is often incorrectly assumed that these organisms are the prime etiologic factors. Second, the parasitic group, including amebic colitis and bacillary dysentery, typhoid fever and other acute and chronic infections, such as pyemia. Ordinarily, the first two present no difficulties in diagnosis. With acute infections such as pyemia, as seen in puerperal sepsis, the streptococcus often is directly responsible for the intestinal lesion. Among the chronic infections, which are by far the most interesting, we find a variety of organisms. Bargen has described a streptococcus morphologically similar to the enterococcus but differing in its serologic reactions. The enterococcus itself is occasionally found. Some observers have found an organism resembling pneumococcus. In the cases cited, the first and fourth undoubtedly fall into this last group. The first case gave a uremic history and closely resembled one of our cases at Temple University. In the latter, an elongated encapsulated streptococcus was found in the intestinal mucosa which resembled, at least morphologically, the one described by Bargen. From the facts presented, one is justified in assuming that there occur in pregnancy cases of colitis in which a definite organism is demonstrable, and that this organism is an elongated, encapsulated diplococcus. Whether it represents a single type or whether there are many varieties of organisms presenting this peculiar morphology, is yet to be learned. Certainly, all cases of colitis occurring in pregnancy should be studied bacteriologically either by making cultures of the stools, or when possible, by direct smears from the mucosa of the lower bowel, and careful cultural phenomena, as well as serologic reactions, should be determined with the organism in each case.
CHICAGO STATED
GYNECOLOGICAL MEETING,
DECEMBER
SOCIETY 19, 1990
DR. JAMES B, HERRICK presented a Memorial Tribute to the Late Dr. Charles E. Paddock, a member of the Society. DR. ALEXANDER G. GABRIELIANZ presented a paper on Spinal An&the.
sia in Gynecology. DR. J. P. GREENHILL
described Rupture
traabdominal Hemorrhage (See page 902.)
of a Corpus Luteum With Inand presented a Report of Three Cues.