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Clostridium difficile ileitis in a patient, after total colectomy
Aneta Tarasiuk-Rusek1, Kairav J Shah2
1Division of Infectious Diseases and Global Medicine, University of Florida, Gainesville, Florida, USA.
Insights
A post-colectomy patient experienced Clostridium difficile infection (CDI) symptoms including diarrhea and fever. Prompt treatment with vancomycin and flagyl led to symptom resolution and discharge.
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.
Abstract:
This is a case of a 63-year-old, post total colectomy patient, who presented to the hospital with watery diarrhoea, abdominal cramping and fevers. On admission, the patient was haemodynamically stable and febrile. Clostridium difficile PCR was sent and tested positive. CT of the abdomen revealed diffuse thickening of the distal small bowel to the level of the anastomosis and mesenteric oedema consistent with infectious enteritis. The patient was started on vancomycin orally as well as flagyl intravenously. Because of an ileus, he initially was treated with bowel rest and a NG tube. Surgical consult was obtained early with no intervention. The patient's symptoms progressively resolved over the next 7 days of hospitalisation, and he was discharged home.
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