Pseudomembranous Colitis Presenting with Dual Colonic Perforation in a 15 Year Old Female- A Rare Case Rreport

Document Type : Case Report

Authors

Department of Surgery, School of Medicine, Dr D.Y Patil Demeed to be University, Navi Mumbai, India

Abstract

Pseudomembranous colitis is an undesirable complication of C difficle infection. C difficle, although a part of normal gut flora, can become a nuisance and cause varying degrees of colitis, given the opportunity of a conducive host environment. Pseudomembranous colitis is managed medically with metronidazole or vancomycin, but can progress to toxic megacolon in upto 3% of cases. This dire complication may necessitate surgical management and is associated with a high mortality rate. Our case is a 15 year old, otherwise healthy patient who presented with perforative peritonitis with septic shock and diagnosed with dual colonic perforations on exploratory laparotomy. Pathological analysis of the specimen suggested presence of pseudomembranous throughout the resected segment of the colon. We suggest considering PMC as a differential diagnosis in a complicated toxic megacolon, regardless of the age of the patient, duration of antibiotic therapy and underlying diagnosis, particularly when there is an obscure history and diagnostic uncertainty.

Keywords

References

  1. Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and
    colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 1997
    May;92(5):739-50. PMID: 9149180.
  2. Smits, Wiep Klaas, et al. “Clostridium difficile infection.” Nature reviews Disease primers 2.1 (2016): 1-20.
  3. Khan, Fahmi Yousef, and Abdul- Naser Elzouki. “Clostridium difficile infection: a review of the literature.”
    Asian Pacific journal of tropical medicine 7 (2014): S6-S13.
  4. Burke, Kristin E., and J. Thomas Lamont. “Clostridium difficile infection: a worldwide disease.”                                  Gut and liver 8.1 (2014): 1.
  5. Farooq PD, Urrunaga NH, Tang DM, von Rosenvinge EC. Pseudomembranous colitis. Dis Mon. 2015 May;61(5):181-206. doi: 10.1016/j.disamonth.2015.01.006. Epub 2015 Mar 11.                                                      PMID: 25769243; PMCID: PMC4402243.
  6. Sayedy L, Kothari D, Richards RJ. Toxic megacolon associated Clostridium difficile colitis. World J Gastrointest Endosc. 2010 Aug 16;2(8):293-7. doi: 10.4253/wjge. v2.i8.293. PMID: 21160629; PMCID: PMC2999149
  7. Bradley, S. J., et al. “Surgical management of pseudomembranous colitis.”                                                                 The American Surgeon 54.6 (1988): 329-332.
  8. Surawicz, ChristinaM, and LynneV McFarland. “Pseudomembranous colitis: causes and cures.”                               Digestion 60.2 (1999): 91-100.
  9. Carpenter, Herschel A., and Nicholas J. Talley. “The importance of clinicopathological correlation in the
    diagnosis of inflammatory conditions of the colon: histological patterns with clinical implications.” The American
    journal of gastroenterology 95.4 (2000): 878-896.
  10. Mylonakis, Eleftherios, Edward T. Ryan, and Stephen B. Calderwood. “Clostridium difficile–associated
    diarrhea: a review.” Archives of Internal Medicine 161.4 (2001): 525-533.
  11. Johnson, Stuart. “Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes.” Journal of Infection 58.6 (2009): 403-410.
  12. Byrn, John C., et al. “Predictors of mortality after colectomy for fulminant Clostridium difficile colitis.” Archives of surgery 143.2 (2008): 150-154.
  13. Feuerstadt P, Brandt LJ. Colon ischemia: recent insights and advances. Curr Gastroenterol Rep. 2010 Oct;12(5):383-90. doi: 10.1007/ s11894-010-0127-y. PMID: 20690005.
  14. Goodgame RW. Gastrointestinal cytomegalovirus disease. Ann Intern Med. 1993 Nov 1;119(9):924-35. doi:
    10.7326/0003-4819-119-9-199311010-00010. PMID: 8215005.
  15. Kilinçalp S, Altinbaş A, Başar O, Deveci M, Yüksel O. A case of ulcerative colitis co-existing with pseudo-membranous enterocolitis. J Crohns Colitis. 2011 Oct;5(5):506-7. doi: 10.1016/j.crohns.2011.06.012. Epub 2011 Aug 2. PMID: 21939932.
  16. Kawamoto, Satomi, Karen M. Horton, and Elliot K. Fishman. “Pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation.” Radiographics 19.4 (1999): 887-897.
  17. Downey, Donal B., and S. R. Wilson. “Pseudomembranous colitis: sonographic features.” Radiology
    180.1 (1991): 61-64.i
  18. Marshak, R. H. “Case report: megacolon, a complication of ulcerative colitis.” Gastroenterol 16 (1950): 768-772.
  19. Berman L, Carling T, Fitzgerald TN, Bell RL, Duffy AJ, Longo WE, Roberts KE. Defining surgical therapy
    for pseudomembranous colitis with toxic megacolon. J Clin Gastroenterol. 2008 May-Jun;42(5):476-80. doi:
    10.1097/MCG.0b013e31804bbe12. PMID: 18277885.
  20. Longo WE, Mazuski JE, Virgo KS, Lee P, Bahadursingh AN, Johnson FE. Outcome after colectomy for Clostridium difficile colitis. Dis Colon Rectum. 2004 Oct;47(10):1620-6. doi: 10.1007/s10350-004-0672-2. PMID: 15540290.
  21. Cone, John B., and William Wetzel. “Toxic megacolon secondary to pseudomembranous colitis.” Diseases
    of the Colon & Rectum 25.5 (1982): 478-482.
  22. Ber man, Loren, et al. “Defining surgical therapy for pseudomembranous colitis with toxic megacolon.” Journal of clinical gastroenterology 42.5 (2008): 476-480.
  23. Gan, S. Ian, and P. L. Beck. “A new look at toxic megacolon: an update and review of incidence, etiology,
    pathogenesis, and management.” The American journal of gastroenterology 98.11 (2003): 2363-2371.
  24. Trudel, Judith L., et al. “Toxic megacolon compl ica t ing pseudomembranous enterocolitis.”
    Diseases of the colon & rectum 38.10 (1995): 1033-1038.
  25. Shetler K, Nieuwenhuis R, Wren SM, Triadafilopoulos G. Decompressive colonoscopy with intracolonic
    vancomycin administ ration for the treatment of severe pseudomembranous colitis. Surg Endosc. 2001 Jul;15(7):653-9. doi: 10.1007/s004640080104. Epub 2001 May 7. PMID: 11591962.
  26. Panos MZ, Wood MJ, Asquith P. Toxic megacolon: the knee-elbow position relieves bowel distension. Gut. 1993 Dec;34(12):1726-7. doi: 10.1136/gut.34.12.1726. PMID: 8282262; PMCID: PMC1374472.
  27. Johal, S. S., et al. “Clostridium difficile associated diarrhoea in hospitalised patients: onset in the community and hospital and role of flexible sigmoidoscopy.” Gut 53.5 (2004): 673-677.
  28. Grundfest-Broniatowski S, Quader M, Alexander F, Walsh RM, Lavery I, Milsom J. Clostridium difficile colitis
    in the critically ill. Dis Colon Rectum. 1996 Jun;39(6):619-23. doi: 10.1007/ BF02056938. PMID: 8646945.
Iranian Journal of Colorectal Research
Volume 10, Issue 4
December 2022
Pages 160-163

Files

Share

How to cite

Statistics