Post-esophagectomy pseudomembranous inflammation of the interposed colon.
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.
Al-Mufarrej
Faisal
F
George Washington University Medical Center, Washington, DC, USA. faisal@gwu.edu
Margolis
Marc
M
Tempesta
Barbara
B
Strother
Eric
E
Gharagozloo
Farid
F
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
D000900:Anti-Bacterial Agents; D014640:Vancomycin