Pseudomembranous enterocolitis after gynecologic endoscopy

A 21-year-old nulligravida underwent diagnostic hysteroscopy and laparoscopic potassium-titanyl-phosphate laser ablation of pelvic peritoneal endometriosis (revised American Fertility score of 10) for dysmenorrhea, dyspareunia, and dyschezia. Preoperatively the patient had an electrolyte bowel preparation but no antibiotic prophylaxis. Six days postoperatively she developed symptoms of nausea, vomiting, and diarrhea, which were not affected by diet and over-the-counter bowel medications. Examination of stool samples for culture, ova, parasites, and Clostridium difficile toxin led to the diagnosis of C. difficile pseudomembranous enterocolitis. The patient was referred to a gastroenterologist. She required 4 months of metronidazole therapy, including two hospitalizations, before her symptoms resolved. The stool assay became negative for C. difficile toxin 6 months after surgery. Pseudomembranous enterocolitis may occur rarely in patients without the usual risk factors of antibiotic therapy. The role of electrolyte bowel preparation is uncertain, but it may have permitted overgrowth of C. difficile.