title: Post-esophagectomy pseudomembranous inflammation of the interposed colon.
abstract: BACKGROUND
  Pseudomembranous colitis (PMC) usually is caused by antibiotic-related changes in colonic anaerobic microflora, leading to Clostridium difficile overgrowth and overproduction of toxins. We present the first reported case of PMC affecting the intrathoracic, interposed colon of an esophagectomy patient in the absence of inflammation of the in situ colon.
  
  
  METHODS
  Case report and review of pertinent English-language literature.
  
  
  METHODS
  A 47 year-old male developed Clostridium difficile-related colitis after in Ivor-Lewis esophagectomy for carcinoma of the esophagus, and rendered asymptomatic after 10 days of therapy with oral vancomycin. Postoperatively, the patient developed a broncho-esophageal fistula, and was reconstructed with a two-stage colonic esophageal colonic interposition three months after the fistula was closed surgically. On postoperative day nine, the patient developed symptomatic PMC of the interposed colon segment, whereas the in situ colon was spared. Therapy with oral vancomycin for three weeks eradicated the infection.
  
  
  CONCLUSIONS
  Pseudomembranous colitismay develop in the interposed colon after a esophageal colonic interposition, even absent inflammation of the in situ colon. Previous infection with C. difficile may have increased the risk in this patient.
authors.affiliation: George Washington University Medical Center, Washington, DC, USA. faisal@gwu.edu
authors.forename: Faisal
authors.initials: F
authors.lastname: Al-Mufarrej
authors.forename: Marc
authors.initials: M
authors.lastname: Margolis
authors.forename: Barbara
authors.initials: B
authors.lastname: Tempesta
authors.forename: Eric
authors.initials: E
authors.lastname: Strother
authors.forename: Farid
authors.initials: F
authors.lastname: Gharagozloo
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003106:Colon / Q000473:pathology; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000382:microbiology; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000382:microbiology; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin