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Drug-induced colitis mimicking an acute surgical condition of the abdomen
Abstract:
Pseudomembranous colitis secondary to antibiotic therapy has received increasing recognition. During a one-year period, eight of 42 patients with this entity had findings closely resembling an acute surgical condition of the abdomen manifested by fever, leukocytosis, and severe abdominal pain and tenderness. All eight patients received clindamycin and two were also given lincomycin hydrochloride monohydrate. Differentiation from an acute surgical condition of the abdomen was difficult until the characteristic findings of pseudomembranous colitis were noted on proctoscopic examination. Unnecessary celiotomy was averted in all patients. Seven of eight patients responded to discontinuation of the antibiotic and supportive measures; one required a diverting ileostomy. Drug-induced colitis must be an important consideration in any patient recently receiving antibiotics who develops fever, abdominal pain, and diarrhea.
Insights
Antibiotic-associated pseudomembranous colitis can mimic surgical emergencies. Early proctoscopic examination is crucial for differentiating this condition from acute abdominal surgical issues, preventing unnecessary surgery.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Infectious Diseases
Background:
- Antibiotic-associated pseudomembranous colitis is increasingly recognized.
- This condition can present with symptoms mimicking acute surgical abdominal conditions.
Purpose of the Study:
- To highlight the diagnostic challenges of pseudomembranous colitis.
- To emphasize the importance of proctoscopic examination in differentiating it from surgical emergencies.
Main Methods:
- Retrospective review of 42 patients over one year.
- Clinical presentation analysis, including fever, leukocytosis, abdominal pain, and tenderness.
- Proctoscopic examination findings.
Main Results:
- Eight patients (19%) presented with symptoms mimicking acute surgical abdomen.
- All eight patients had received clindamycin, with two also receiving lincomycin.
- Proctoscopic examination confirmed pseudomembranous colitis, averting unnecessary surgery in all cases.
- Seven patients improved with antibiotic discontinuation and supportive care; one required a diverting ileostomy.
Conclusions:
- Pseudomembranous colitis should be considered in patients with recent antibiotic use presenting with abdominal pain and fever.
- Proctoscopic examination is vital for accurate diagnosis and avoiding surgical intervention.
- Prompt recognition and management lead to favorable outcomes.