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Updated: Jun 21, 2026
04:05
A Rat Model of Pouchitis Following Proctocolectomy and Ileal Pouch-Anal Anastomosis Using Dextran Sulfate Sodium
Published on: May 31, 2024
Fulminant Clostridium difficile-associated pouchitis with a fatal outcome
Bo Shen1, Feza H Remzi, Victor W Fazio
1Digestive Disease Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA.
Nature Reviews. Gastroenterology & Hepatology
|August 6, 2009
Summary
A patient developed severe Clostridium difficile-associated pouchitis and enteritis after ileostomy closure. This led to fatal Pseudomonas aeruginosa septicemia and multi-organ failure despite aggressive treatment.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- A 61-year-old woman with a history of ulcerative colitis underwent ileostomy closure.
- She previously had a total proctocolectomy with ileal-pouch-anal anastomosis for steroid-refractory disease.
Observation:
- The patient presented with abdominal pain, vomiting, diarrhea, dehydration, and oliguria 10 days post-closure.
- Investigations included physical examination, CT scan, laboratory tests, pouch endoscopy, and C. difficile toxin testing.
Findings:
- Diagnosis of fulminant Clostridium difficile-associated pouchitis and enteritis.
- Complications included Pseudomonas aeruginosa septicemia, intravascular coagulopathy, acute renal failure, hemorrhagic ascites, and respiratory failure.
- The patient ultimately died from these complications.
Implications:
- Highlights the risk of severe C. difficile infection post-proctocolectomy and ileostomy closure.
- Underscores the importance of prompt diagnosis and aggressive management of pouchitis and enteritis.
- Emphasizes the potential for rapid deterioration and multi-organ failure in severe cases.
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