Conservative surgical treatment for toxic megacolon due to  Clostridium difficile infection in a transplanted pediatric patient.
Severe disease caused by Clostridium difficile is frequently encountered in transplant recipients and carries a high mortality. Numerous studies have been published on this subject in the adult population, but few in the pediatric setting. A 4-year-old boy who had undergone heart transplant 20 months earlier was admitted to the pediatric intensive care unit after humoral rejection. Seven days after admission, he developed septic shock, abdominal distension, and paralytic ileus without diarrhea. Pseudomembranous colitis due to C. difficile was confirmed by microbiological and radiological studies. Despite treatment with rectal vancomycin and intravenous metronidazole, the patient did not improve and required decompressive laparotomy; because of the poor subsequent clinical course, terminal ileostomy and cecostomy were performed in a second operation. Recovery was satisfactory, and surgical reconstruction of intestinal tract was performed 3 months later without complications. Although early surgery with total colectomy is indicated, when there is a poor response to medical treatment in cases of C. difficile toxic megacolon, the case we present responded favorably to a conservative surgical approach that enabled intestinal integrity to be restored 3 months later. In the pediatric population, less aggressive therapeutic options should be considered, as they have benefits on the subsequent quality of life of the patient.
Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
A
A
Castillo
J
J
López
E
E
Panadero
J
J
Cerdá
B
B
Padilla
A
A
Bustinza
D002431:Cecostomy; D002675:Child, Preschool; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000382:microbiology / Q000601:surgery*; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007081:Ileostomy; D008297:Male; D008532:Megacolon, Toxic / Q000382:microbiology* / Q000601:surgery*; D016896:Treatment Outcome