Clostridium difficile ileitis in a patient, after total colectomy.

Area of Science:

• Gastroenterology
• Infectious Diseases
• Colorectal Surgery

Background:

• Clostridium difficile infection (CDI) is a significant cause of infectious diarrhea, particularly in post-surgical patients.
• Total colectomy increases the risk of altered gut microbiota and susceptibility to enteric infections.
• Early recognition and management of CDI are crucial for patient outcomes.

Observation:

• A 63-year-old patient, status post total colectomy, presented with watery diarrhea, abdominal cramping, and fever.
• Abdominal CT revealed diffuse small bowel thickening and mesenteric edema, indicative of infectious enteritis.
• Clostridium difficile PCR testing confirmed the presence of infection.

Findings:

• The patient received oral vancomycin and intravenous metronidazole (flagyl).
• Initial management included bowel rest and nasogastric (NG) tube placement due to ileus.
• Symptoms resolved within 7 days, leading to successful hospital discharge.

Implications:

• This case highlights the importance of considering CDI in post-colectomy patients presenting with gastrointestinal symptoms.
• Appropriate antibiotic therapy and supportive care can effectively manage CDI in this high-risk population.
• Multidisciplinary collaboration, including surgical consultation, is valuable in complex cases.