“Diversion” Colitis Caused by Clostridium difficile Infection: Report of a Case

Abstract

Recurrent ulcerative colitis and/or diversion colitis occur commonly in the rectal remnant after colectomy for ulcerative colitis. We report a case in which such a patient's symptoms of rectal discharge were initially thought to be the result of one or both of these diagnoses, on both clinical and histologic grounds. However, examination of the discharge revealed Clostridium difficile infection. Treatment with metronidazole suppositories improved his symptoms and avoided further inappropriate intervention.

Clostridium difficileInfection and Inflammatory Bowel Disease: A Review

“…High ileostomy output accompanied by abdominal tenderness, nausea, fever, and high leukocyte count are the usual presenting complaints [57]. There have also been case reports of C. difficile causing diversion colitis and pouchitis in postcolectomy cases [58–61]. …”

Systematic review: Clostridium difficile and inflammatory bowel disease

“…On multivariate analysis, risk factors associated with CDI included male gender (OR 5.1 [95% CI, 1.4–20.5) and distal disease preoperatively (OR 8.4 [95%CI1.3–56.4]. Clostridium difficile infection has been reported to cause an acute enteritis in IBD patients with ileostomies in several case studies (for review 81 ) and colitis in the rectal stump of a patient with ileostomy and sub‐total colectomy for UC 82 …”

A case of fulminant diversion pan-colitis presenting 19 years after colonic diversion for neuronal intestinal dysplasia

“…Diversion colitis therefore needs to be distinguished from other disorders 5 – 7. A case of diversion colitis presenting with massive rectal distension and bilateral ureteric obstruction has been previously reported,8 but our report is the first in the English literature of a life threatening fulminant diversion colitis.…”