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Antibiotic associated pseudomembranous colitis with negative proctosigmoidoscopy examination.
Antibiotic-associated pseudomembranous colitis can be missed by standard proctosigmoidoscopy. Total colonoscopy revealed pseudomembranes in the colon, even when rectal mucosa appeared normal, highlighting a diagnostic challenge.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Colorectal Surgery
Background:
- Diagnosis of antibiotic-associated pseudomembranous colitis (AAPC) traditionally relies on proctosigmoidoscopy.
- Previous studies emphasize the rectosigmoid area for diagnosis.
Purpose of the Study:
- To investigate the diagnostic utility of total colonoscopy in identifying AAPC.
- To assess the occurrence of AAPC when the rectosigmoid mucosa is normal or only edematous.
Main Methods:
- Study included 6 patients with stool evidence of clostridial toxin.
- Patients underwent total colonoscopy.
- Rectal and colonic mucosa were examined for pseudomembranes.
Main Results:
- Five of six patients showed pseudomembranes in various colonic segments.
- The rectosigmoid area was uninvolved in these cases.
- This indicates AAPC can occur with rectal sparing.
Conclusions:
- Routine proctosigmoidoscopy may miss cases of AAPC due to rectal sparing.
- Further research is needed to determine the incidence of rectal sparing in AAPC.
- Diagnostic strategies for AAPC should consider the possibility of pseudomembranes beyond the rectosigmoid.
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