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Pseudomembranous enteritis after proctocolectomy: report of a case
Z Vesoulis1, G Williams, B Matthews
1Department of Pathology, Akron City Hospital (Summa Health Systems), Ohio 44304, USA.
Abstract:
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.
Insights
Antibiotic-associated diarrhea can cause pseudomembranes in the small intestine, not just the colon. This rare condition, pseudomembranous enteritis, requires consideration in post-colectomy patients with specific symptoms.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Antibiotic-associated diarrhea (AAD) typically involves the colon.
- Pseudomembrane formation is a known complication of AAD, usually limited to the colon.
Observation:
- A patient with prior proctocolectomy presented with septic shock after antibiotic use.
- Small bowel resection revealed extensive pseudomembranes positive for Clostridium difficile.
- Ileostomy drainage tested positive for C. difficile toxin A.
Findings:
- Histopathology of the small bowel resection showed features similar to pseudomembranous colitis.
- This suggests C. difficile can cause pseudomembranous enteritis.
- The small intestine may serve as a reservoir for C. difficile.
Implications:
- Antibiotic-treated patients, especially post-colectomy, may be susceptible to C. difficile overgrowth in the small bowel.
- Pseudomembranous enteritis should be considered in patients with purulent ostomy drainage, abdominal pain, fever, leukocytosis, or septic shock.
- Metronidazole treatment was successful in this case.