Document Detail


Post-esophagectomy pseudomembranous inflammation of the interposed colon.
MedLine Citation:
PMID:  20858162     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pseudomembranous colitis (PMC) usually is caused by antibiotic-related changes in colonic anaerobic microflora, leading to Clostridium difficile overgrowth and overproduction of toxins. We present the first reported case of PMC affecting the intrathoracic, interposed colon of an esophagectomy patient in the absence of inflammation of the in situ colon.
METHODS: Case report and review of pertinent English-language literature.
CASE REPORT: A 47 year-old male developed Clostridium difficile-related colitis after in Ivor-Lewis esophagectomy for carcinoma of the esophagus, and rendered asymptomatic after 10 days of therapy with oral vancomycin. Postoperatively, the patient developed a broncho-esophageal fistula, and was reconstructed with a two-stage colonic esophageal colonic interposition three months after the fistula was closed surgically. On postoperative day nine, the patient developed symptomatic PMC of the interposed colon segment, whereas the in situ colon was spared. Therapy with oral vancomycin for three weeks eradicated the infection.
CONCLUSIONS: Pseudomembranous colitismay develop in the interposed colon after a esophageal colonic interposition, even absent inflammation of the in situ colon. Previous infection with C. difficile may have increased the risk in this patient.
Authors:
Faisal Al-Mufarrej; Marc Margolis; Barbara Tempesta; Eric Strother; Farid Gharagozloo
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Surgical infections     Volume:  11     ISSN:  1557-8674     ISO Abbreviation:  Surg Infect (Larchmt)     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-22     Completed Date:  2011-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815642     Medline TA:  Surg Infect (Larchmt)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  479-81     Citation Subset:  IM    
Affiliation:
George Washington University Medical Center, Washington, DC, USA. faisal@gwu.edu
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Anti-Bacterial Agents / administration & dosage
Clostridium difficile / isolation & purification*
Colon / pathology
Enterocolitis, Pseudomembranous / diagnosis*,  microbiology
Esophagectomy / adverse effects*
Humans
Male
Middle Aged
Postoperative Complications / diagnosis*,  microbiology
Vancomycin / administration & dosage
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 1404-90-6/Vancomycin

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


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