[Percutaneous endoscopic colostomy for treatment of an antibiotic-induced pseudomembranous colitis]

A 61-year-old man was admitted with diffuse abdominal pain and diarrhea for one week. A few weeks before admission he had been given antibiotics for an exacerbation of his chronic obstructive pulmonary disease. On physical examination he presented with bronchospasm, abdominal tenderness, active bowel sounds and slight edema in both legs.

Blood tests detected an acute inflammation and colonoscopy revealed a massive inflammation of the bowel with pseudomembranes. Clostridium difficile and Clostridium toxin was isolated from the feces.

Oral antibiotic treatment with metronidazole and thereafter vancomycin was without effect. However, the colitis receded rapidly after vancomycin was given into the colon via a percutaneous endoscopic colostomy placed in the proximal ascending colon.

There are increasing numbers of reports on severe Clostridium colitis. The percutaneous endoscopic colostomy with local application of antibiotics may improve outcome.