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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.
Diseases of the Colon and Rectum
|May 2, 2000
Summary
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.