Clostridium difficile extraintestinal abscess: a rare complication

Area of Science:

• Gastroenterology
• Infectious Diseases
• Abdominal Surgery

Background:

• Extraintestinal Clostridium difficile infection (CDI) is a rare but serious complication.
• A 74-year-old male with ulcerative colitis and liver cirrhosis presented with symptoms suggestive of recurrent CDI.
• Initial presentation involved abdominal pain, distension, diarrhea, and leukocytosis, with stool testing positive for C. difficile.

Observation:

• Computed tomography (CT) revealed pancolitis with toxic megacolon, necessitating a total abdominal colectomy and ileostomy.
• The patient was readmitted with sepsis, and a subsequent CT scan identified a large pelvic abscess.
• Drainage of the pelvic abscess yielded C. difficile, despite negative stool cultures at readmission.

Findings:

• The pelvic abscess was successfully treated with CT-guided drainage and a 2-week course of metronidazole.
• Barium enema excluded a direct communication between the rectal stump and the abscess.
• Extraintestinal CDI can arise from factors including recent antibiotic use, gastrointestinal surgery, and microperforations associated with toxic megacolon.

Implications:

• Early recognition and management of extraintestinal CDI are crucial.
• Treatment strategies should include abscess drainage and appropriate antimicrobial therapy (metronidazole and/or vancomycin).
• Follow-up imaging is recommended to ensure complete resolution of the abscess after antibiotic cessation.