CASE HISTORY

This patient was admitted for a perforated peptic ulcer. Three weeks later she developed ulcerative procto-colitis for which she was treated with cortisone. A fortnight later she developed blood-stained diarrhoea and the colon was resected. The specimen showed severe ulcerative colitis. After the operation she put on weight, her condition improved and she was discharged. She was readmitted six months later with vomiting and melaena and required a blood transfusion. A Bilroth I gastrectomy was performed for a bleeding ulcer which was found to be in duodenum. Subsequently she developed a rectal abscess. Polythene catheters had been inserted into both femoral veins, in spite of antibiotic treatment she went steadily downhill and died. At PM she still had persistent ulceration in the rectal stump as well as the fatal pyaemia.

PATHOLOGY

The following tissues have been mounted. The lowest part of the inferior vena cava, the apical part of the right lung, the dorsal spine and half of the kidney. The inferior vena cava contains thrombus which is partly red, partly pink and partly green-coloured. The latter part is manifestly infected and from this numerous minute fragments have broken away as septic emboli and have embedded in the pulmonary arteries producing innumerable small abscessed. These are seen in the specimen of lung. Some are extremely small and other are nearly 1 cm in diameter and consist of abscesses with slightly reddened walls. Externally, there is a little local pleurisy over the larger ones and red rings can often be seen around some of the abscesses. The forth dorsal vertebra shows embolic osteomyelitis with formation of numerous small abscesses in the marrow cavity but without apparent bony destruction. The kidney also shows pyaemic abscesses. These are seen in both cortex and medulla. The former are more easily seen from the capsular surface as raised white points, nearly all under 1mm. in diameter. The medullary abscesses are seen on the cut surface as white points surrounded by a thin red zone of congestion. Cultures grew staphylococcus pyogenes.