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Clinical Case Summary

Clostridium perfringens is a gram-positive spore-forming anaerobic bacillus belonging to the family of Clostridiaceae, which can be found everywhere in nature and is also a component of the human intestinal and genital tract. Its virulence depends on the production of different toxins.
In our clinical case, a 71-year-old Caucasian male was transferred from the emergency department of a hospital in Bavaria to our intensive care unit due to acute liver failure. On arrival at our hospital, we measured elevated heart frequency and elevated breathing-rate with the need for oxygen supplementation via a mask, the general state of the patient was reduced, and the GCS was 5. The laboratory showed elevated kidney markers, elevated liver enzymes (AST 209 U/l, ALT 135 U/l, Bilirubin 22.1 mg/dl), restricted coagulation (INR 1.29, Quick 65 %), elevated infection-markers (CRP 386 mg/l, PCT 19.40 ng/ml, Leukocytes 21.05 /nl) and a highly increased LDH (915 U/l). Most important, a CT scan revealed pneumobilia.
Due to the results of the pneumobilia without a history of a recently performed GI endoscopy, an infection with Clostridium perfringens was suspected, and antibiotic treatment with Meropenem, Metronidazole, Penicillin, and Clindamycin was initiated. The patient recovered within a few days and was transferred to the regular ward after five days. Blood cultures confirmed infection with Clostridium perfringens later on. After recovery, the patient reported that he had worked in his garden one week before admission to the ICU and had suffered a minor injury to his hand while gardening. The patient fully recovered after another ten days and was discharged in excellent condition.
Our case shows that pneumobilia without a history of a recently performed GI endoscopy can be an important hint for infection with Clostridium perfringens in patients presenting with acute liver failure. Rapid diagnosis and treatment are live saving in patients with Clostridium perfringens infections.

PNEUMOBILIA AS A HINT FOR RAPID DIAGNOSIS AND TREATMENT OF CLOSTRIDIUM PERFRINGENS IN A PATIENT WITH ACUTE LIVER AND MULTIORGAN FAILURE

Bernhard Michels 1, Sheila Abaladejo-Fuertes 1, Bettina Seydel 1, Alexander Mehrl 1, Karsten Gülow 1, Vlad Pavel 1, Martina Müller-Schilling 1, Stephan Schmid 1

1 University Hospital Regensburg, Regensburg, Germany

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

UEG Standards and Guidelines

Consensus

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Abstract

Background

The incidence and prevalence of inflammatory bowel disease [IBD] have increased significantly in low- and middle-income countries [LMICs] in recent decades. Managing IBD in these settings presents substantial challenges. This consensus aims to describe the epidemiology of IBD in LMICs and to highlight the key challenges in its diagnosis and treatment.

Method

The consensus-defining strategy followed the previous European Crohn’s and Colitis Organisation [ECCO] consensus guidelines [available at www.ecco-ibd.eu]. The authors reviewed the available evidence and formulated statements accordingly. Provisional ECCO statements and supporting text were drafted based on a comprehensive literature review and further refined through two voting rounds, which included external reviewers and national representatives from ECCO’s 36 member countries. The final ECCO statements, representing a consensus of at least 80% agreement among participants, were approved during an online meeting. Consensus statements should be interpreted in context with their accompanying commentary rather than in isolation and should not be used solely to guide patient management. The supporting text was finalized under the guidance of each working group leader [VP, HY, TK, AH] and subsequently integrated by the consensus leader [AE].

Results

Data on IBD epidemiology in LMICs remain limited. Public and healthcare professional awareness and timely access to early diagnostic modalities, advanced medical and surgical therapies, and specialist multidisciplinary care are key gaps in IBD care in LMICs. The complexity and chronic nature of IBD, along with the necessity for a multidisciplinary approach, pose significant challenges to adopting a holistic management strategy in LMICs.

Conclusion

There is a critical need for further studies to assess the specific needs of LMICs. Such research will help guide resource allocation and improve IBD management in these settings.

ECCO Consensus on management of Inflammatory Bowel Disease in low-and middle-income countries

Alaa El-Hussuna

Publisher

European Crohn’s and Colitis Organisation

Guideline

Consensus

Topics

IBD

Citation

Journal of Crohn's and Colitis; 2025

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

The current consensus guideline offers a comprehensive and practical guidance on the diagnostic and monitoring of patients with inflammatory bowel disease (IBD). It provides recommendations on requirements for initial diagnosis, detection of complications, the use of monitoring tools in patients with IBD and diagnostics in specific situations, such as pregnancy, postoperatively and for cancer surveillance. The guideline is a joint project of the European Crohn’s and Colitis Organization (ECCO), the European Society of Gastrointestinal and Abdominal Radiology, the European Society of Pathology, and the International Bowel Ultrasonography Group under the leadership of ECCO.

ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 1: initial diagnosis, monitoring of known inflammatory bowel disease, detection of complications

Torsten Kucharzik

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 19, Issue 7

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Introduction

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), requires meticulous diagnostic and monitoring protocols to optimize patient outcomes. This document synthesizes key advancements and recommendations for clinical indices, endoscopic scoring, imaging, histological assessment, and tools for evaluating IBD disability. Emphasizing validated, reproducible methods aligns with the ongoing evolution of precision medicine in IBD care, including training. The methodology of the guidelines update process is described in part 1.

ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 2: IBD scores and general principles and technical aspects

Henit Yanai

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 19, Issue 7

Published

2025

UEG Mistakes In Articles

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Crohn’s disease (CD) is a chronic inflammatory bowel condition that can present with a wide range of intestinal and extra-intestinal manifestations. This condition can develop at any age and have a significant impact and impairment on quality of life for individuals including on relationships, educational attainment and work productivity. In particular, the time around and after diagnosis often involves the most upheaval for patients, and equally the biggest opportunity for effective intervention. Several recent advances have had a major impact on optimal management of patients with newly diagnosed CD. Here, we discuss the mistakes that are commonly made when managing patients presenting with a new diagnosis of CD. We summarise the evidence base and offer helpful and pragmatic tips for practising clinicians.

Mistakes in newly diagnosed Crohn's disease and how to avoid them

Joana Roseira, Nurulamin Noor

Topics

IBD

Citation

Roseira J and Noor N. Mistakes in newly diagnosed crohn's disease and how to avoid them. UEG Education 2025; 25: 18-23.

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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MAIN RECOMMENDATIONS

ESGE recommends the combination of endoscopic ultrasound-guided tissue acquisition (EUS-TA) and endoscopic retrograde cholangiopancreatography (ERCP)-based tissue acquisition as the preferred diagnostic approach for tissue acquisition in patients with jaundice and distal extrahepatic biliary stricture in the absence of a pancreatic mass.
ESGE suggests that brushing cytology should be completed along with fluoroscopy-guided biopsies, wherever technically feasible, in patients with perihilar biliary strictures.
ESGE suggests EUS-TA for perihilar strictures when ERCP-based modalities yield insufficient results, provided that curative resection is not feasible and/or when cross-sectional imaging has shown accessible extraluminal disease.
SGE suggests using standard ERCP diagnostic modalities at index ERCP. In the case of indeterminate biliary strictures, ESGE suggests cholangioscopy-guided biopsies, in addition to standard ERCP

Diagnostic work-up of bile duct strictures: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Antonio Facciorusso

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy

Citation

Endoscopy 2025; 57: 166-185

Published

2024

UEG Standards and Guidelines

Consensus

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Abstract

Objectives

To provide a consensus statement and recommendations on MR imaging in primary sclerosing cholangitis (PSC).

Methods

The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) convened a multinational European panel of experts selected based on a literature review and their leadership in the field. A modified Delphi process was adopted to draft a list of statements. For each statement, the panelists indicated the level of agreement using a 5-point Likert scale, where 1 means “no agreement,” 2 means “poor agreement,” 3 means “slight agreement,” 4 means “fair agreement,” and 5 means “complete agreement.” The median score for each statement was collected. The level of evidence was reported according to the Oxford Centre for Evidence-Based Medicine. Descriptive statistics were used to rate agreement levels and the consensus’ internal reliability.

Results

The 12 voting committee members were from Italy (n = 4, 33.4%), Austria (n = 2, 16.7%), Sweden (n = 1, 8.3%), France (n = 1, 8.3%), the United States (n = 1, 8.3%), Switzerland (n = 1, 8.3%), and Belgium (n = 2, 16.7%). The final questionnaire consisted of 55 statements. The agreement reached by the expert panel was complete for 23 statements (41.8%), fair for 16 (29.1%), slight for 15 (27.2%), and poor for 1 (1.9%). Statements that received complete agreement were used to structure a reporting template.

Conclusions

This statement paper recommends how and when to perform MRI in PSC patients. A structured reporting template has been created to improve quality care and communication among radiologists and clinicians.

Key Points

Question A standard MR protocol and the most common imaging features to be reported are fundamental for the correct evaluation of primary sclerosing cholangitis (PSC) patients.

Findings Twelve expert radiologists reported which are the most important imaging features and how and when to perform MR in PSC patients.

Clinical relevance The identified statements reported in this paper and the structured reporting template are useful for radiologists and clinicians to help correctly manage PSC patients.

ESGAR consensus statement on MR imaging in primary sclerosing cholangitis

Davide Ippolito

Publisher

European Society of Gastrointestinal and Abdominal Radiology

Guideline

Consensus

Topics

Radiology & Imaging

Citation

Eur Radiol (2025)

Published

2025

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