Document Detail

Clostridium difficile small-bowel enteritis after total proctocolectomy: a rare but fatal, easily missed diagnosis. Report of a case.
MedLine Citation:
PMID:  17468989     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Clostridium difficile enteritis is a rare infection, with less than a dozen cases reported in the literature. We present a case of a patient with total proctocolectomy and ileostomy, developing Clostridium difficile infection of small bowel. We discuss the role of Clostridium difficile toxins and review previously reported cases of Clostridium difficile enteritis after total colectomy. METHODS: A 65-year-old male with a history of total proctocolectomy and ileostomy 30 years previously had purulent ileostomy drainage and septic shock. The patient was recently treated with intravenous piperacillin, tazobactam, and levofloxacin for aspiration pneumonia in the previous admission. Ileostomy stool cultures tested positive for Clostridium difficile toxin A, and the patient was promptly treated with intravenous metronidazole. RESULTS: The patient was aggressively resuscitated and treated, recovered from the enteritis and shock, but died of pulmonary complications after a prolonged hospitalization. CONCLUSIONS: Review of previously reported cases of Clostridium difficile enteritis showed a high mortality rate. We attribute this to delayed diagnosis secondary to rarity of this illness. Some patients were diagnosed only after pseudomembranes in small-bowel segments were found at autopsy. This rare disease entity is firmly established among the differential diagnosis to clinicians treating patients with total proctocolectomy.
Kiup A Kim; Philip Wry; Eugene Hughes; Jeffrey Butcher; Donna Barbot
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  50     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-06-04     Completed Date:  2007-07-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  920-3     Citation Subset:  IM    
Department of Surgery, Graduate Hospital, Philadelphia, Pennsylvania 19146, USA.
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MeSH Terms
Anti-Infective Agents / therapeutic use
Clostridium difficile / isolation & purification*
Enteritis / drug therapy,  microbiology*
Enterocolitis, Pseudomembranous / diagnosis*,  drug therapy
Fatal Outcome
Infusions, Intravenous
Metronidazole / therapeutic use
Postoperative Complications
Proctocolectomy, Restorative
Shock, Septic / drug therapy,  microbiology
Reg. No./Substance:
0/Anti-Infective Agents; 443-48-1/Metronidazole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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