Medline ® Abstracts for References 30,31
of 'Clostridium difficile infection in adults: Clinical manifestations and diagnosis'
Ileal perforation secondary to Clostridium difficile enteritis: report of 2 cases.
Hayetian FD, Read TE, Brozovich M, Garvin RP, Caushaj PF
Arch Surg. 2006;141(1):97.
Two cases of small-bowel perforation secondary to Clostridium difficile enteritis are described and compared with the 8 cases of C difficile enteritis reported in the medical literature. The cause of small-bowel involvement with C difficile is unknown, but prior antibiotic use, prior colectomy, chronic alterations in small-bowel flora, and other host factors are discussed.
Division of Colon and Rectal Surgery, The Western Pennsylvania Hospital, Clinical Campus of Temple University School of Medicine, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
Pseudomembranous enteritis after proctocolectomy: report of a case.
Vesoulis Z, Williams G, Matthews B
Dis Colon Rectum. 2000;43(4):551.
Intestinal pseudomembrane formation, sometimes a manifestation of antibiotic-associated diarrheal illnesses, is typically limited to the colon but rarely may affect the small bowel. A 56-year-old female taking antibiotics, who had undergone proctocolectomy for idiopathic inflammatory bowel disease, presented with septic shock and hypotension. A partial small-bowel resection revealed extensive mucosal pseudomembranes, which were cultured positive for Clostridium difficile. Intestinal drainage contents from an ileostomy were enzyme immunoassay positive for C. difficile toxin A. Gross and histopathologic features of the small-bowel resection specimen were similar to those characteristic of pseudomembranous colitis. The patient was treated successfully with metronidazole. These findings suggest a reservoir for C. difficile also exists in the small intestine and that conditions for enhanced mucosal susceptibility to C. difficile overgrowth may occur in the small-bowel environment of antibiotic-treated patients after colectomy. Pseudomembranous enteritis should be a consideration in those patients who present with purulent ostomy drainage, abdominal pain, fever, leukocytosis, or symptoms of septic shock.
Department of Pathology, Akron City Hospital (Summa Health Systems), Ohio 44304, USA.