Pseudomembranous colitis with associated fulminant ileitis in the defunctionalized limb of a jejunal-ileal bypass

Abstract

Presented is what is believed to be the first reported case of a defunctionalized limb of small intestine serving as a reservoir for Clostridium difficile. Because of the altered intestinal continuity, the ensuing enteritis and colitis failed to respond to nonoperative management. Current treatment strategies are reviewed. Surgical intervention, including restoration of normal gastrointestinal continuity, should be considered early in the hospital course of this patient population.

Fulminant Clostridium difficile Enteritis Causing Abdominal Compartment Syndrome

“…Is it possible that the small intestine acts as a reservoir for C. difficile infection? Kralovich et al published a case report in 1997 of a patient who developed fulminant C. difficile ileitis in a defunctionalized segment of ileum following jejuno-ileal bypass surgery, suggesting that this segment of small bowel was serving as a reservoir for C. difficile infection [18]. If the small intestine does indeed act as a reservoir, perhaps therapy should be targeted at eradication of C. difficile from the small intestine, as this might help to prevent recurrences and progression to fulminant disease.…”

Clostridium difficile Enteritis: An Early Postoperative Complication in Inflammatory Bowel Disease Patients After Colectomy

“…One of these patients received no antibiotics before the episode of C. difficile enteritis. 12 Antibiotic therapy predisposed enteritis in five patients, three for non-GI surgical procedures, [8][9][10] and two for urinary tract infections. 7,11 The final five patients had undergone recent gastrointestinal surgery.…”

Clostridium difficile Small-Bowel Enteritis After Total Proctocolectomy: A Rare But Fatal, Easily Missed Diagnosis. Report of a Case

“…Among all the reported incidences of C. difficile enteritis, the mortality rate is 63 percent (7/11 deaths, including this report). [12][13][14][15][16][17][18][19][20][21][22] The mortality rate for C. difficile enteritis in patients with total colectomy is 60 percent (3/5, including this report). This high mortality rate is to the result of delayed diagnosis secondary to rarity of this illness.…”