Clostridium difficile infection in the absence of a colon.
Clostridium difficile (CD) infection is almost always confined to the colon causing a spectrum of illness ranging from diarrhoea to fulminant colitis. CD infection of the small intestine has been described but the identification of CD toxin in the stoma effluent of a patient with an end ileostomy is rare. We describe a 91-year-old woman, with a history of proctocolectomy for ulcerative colitis, presenting with profuse ileostomy diarrhoea after a course of antibiotics. Ileostomy effluent was positive for CD toxin but the patient died despite appropriate treatment. This suggests that the small intestine is susceptible to CD infection in antibiotic-treated patients many years after a colectomy. CD enteritis should be considered in all patients with increased ileostomy diarrhoea despite the absence of a colon.
Department of Gastroenterology, Royal Free Hospital, London, UK. mohidkhan@doctors.org.uk
Mohid S
MS
Khan
D
D
Levy
S
S
Mann
D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000382:microbiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007081:Ileostomy; D007262:Infusions, Intravenous; D007421:Intestine, Small / Q000382:microbiology; D000077731:Meropenem; D011183:Postoperative Complications / Q000175:diagnosis* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy; D013845:Thienamycins / Q000009:adverse effects / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem