Clostridioides difficile Enteritis Induced Anastomotic Rupture: A Case Report and Literature Review

Abstract

Background. A 76-year-old male patient who suffered small bowel anastomotic dehiscence believed to be a complication provoked by Clostridioides difficile enteritis. Case Presentation. The patient was a 76-year-old male who underwent small bowel resection with primary anastomosis for a small bowel obstruction. On postoperative day #7, he rapidly decompensated and upon return to the operating room was found to have complete anastomotic dehiscence with copious enteric spillage. The presentation appeared as if the staple line had burst open. Enteric contents confirmed the diagnosis of Clostridioides difficile enteritis. Subsequent hospital course was complicated by ventilatory-dependent respiratory failure, hemodynamic instability, and persistent anemia secondary to gastric ulcer requiring endoscopic cauterization. After a prolonged hospital course, he eventually progressed and was transferred to a skilled nursing facility on hospital day #42. Discussion. Clostridioides difficile causes inflammation and copious large volume secretions that would theoretically increase intraluminal pressures creating an internal tension. This tension along with other factors from the infection itself would likely be inhibitory of anastomotic healing. Although it is rare, Clostridioides difficile enteritis is being reported with increasing frequency, and in the setting of recent small bowel anastomosis, it should be considered a possible risk factor for anastomotic leak.

Clostridium difficile infection after ileostomy closure and anastomotic failure in rectal cancer surgery patients

“…A Japanese group also reported seven patients (3.8 per cent) with anastomosis leakage from a cohort of 185 colorectal surgery cases and indicated that CDI was significantly associated with leakage ( P = 0.001). Finally, few case reports of anastomosis rupture related to CDI have been published 13 , 16 . Although the number of cases of anastomosis leakage after ileostomy closure is very small, the current findings indicate a higher rate of leakage in CDI-positive patients versus negative cases (8.7 per cent versus 1.4 per cent, respectively).…”

Clostridioides Difficile Enteritis: Case Report and Literature Review

“…Veterinary studies were excluded, as were basic science studies and articles focusing on pediatric patients (age <18 years). Per our selection strategy, 77 reported cases were identified in 49 publications and our results are presented in Table 1 [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ].…”