An 85-year-old lady with a history of chronic constipation presented with gangrenous small bowel protruding from the anus through a hole in a prolapsed rectum. At surgery, a resection of 125 cm of gangrenous small bowel was performed in the perineum prior to laparotomy, where rectal repair was followed by the creation of a sigmoid loop colostomy and double-barrel ileostomy. This avoided an intrabdominal anastomosis which was felt likely to complicate due to the lady's intraoperative haemodynamic instability requiring inotropic support. This tailored management of a trans-anal small bowel evisceration through a rectal prolapse resulted in recovery and a patient who was content with her stomas and preferred to live with them rather than have continuity restored.

ABSTRACT Pasteurella multocida causes fowl cholera which is an economically important disease in poultry industries around the world. In this study, we analyzed the capsular genotype, lipopolysaccharide (LPS) genotype, virulence-associated genes (VAGs) patterns, antimicrobial resistance and genetic diversity in a total of 9 P. multocida isolates from poultry with fowl cholera between 2014 and 2019 in Korea. When combining the capsular types with the LPS genotypes, two isolates of the 9 isolates were A:L3, and the others were non-typeable (NT): L3. Of the 23 VAGs, all the isolates harbored ptfA, fimA, hsf-1, hsf-2, pfhA, exbB, exbD, tonB, hgbA, hgbB, fur, sodA, sodC, pmHAS, ompA, ompH, oma87, plpB, psl, and nanH, whereas toxA gene was not detected in any of the 9 isolates. In addition, among the 11 antimicrobials, most of the isolates except for one isolate resistant to florfenicol, exhibited susceptibility to all the antimicrobials. Multi-locus sequence typing (MLST) analysis revealed 5 different sequence types (ST): ST8, ST351, ST352, ST353, and ST368. The ST351, ST352, ST353, and ST368 were identified for the first time in this study, and ST352 and ST353 isolates were largely prevalent nationwide. These STs isolates should be monitored continuously because in some cases, ST352 and ST353 isolates demonstrated high mortality rates. Although only limited numbers of isolates have been analyzed, our findings provide overall characteristics and epidemiological information of the P. multocida strains recently prevalent in Korea.