recurrently became hypotensive and was given midodrine. The patient was found to have loose, high-output (approximately 2600 mL/day) from her ileostomy bag. C. difficile PCR returned positive. After an oral vancomycin regimen was begun, the patient's blood pressure improved markedly. The patient's symptoms of dizziness and weakness resolved. Discussion: This case is important to emphasize the consideration of C. difficile infection in loop ileostomy patients presenting with hypotension. Though the patient had noted chronic high-output from her ileostomy bag, the patient did not have a recent prior course of antibiotics and was on a diet inappropriate for an ileostomy. Therefore, given the lack of risk factors, the limited cases of C. difficile enteritis, and no reported cases of C. difficile infection in ileorectal anastomosis and loop ileostomy, diagnosing the C. difficile infection causing hypotension in this patient was challenging. Further reporting of such cases will aid in guidelines, diagnosis, and treatment of C. difficile enteritis.
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