title: Clostridium difficile infection after ileostomy closure mimicking anastomotic leak.
abstract: Clostridium difficile infection is linked to antibiotic exposure, with elderly and immunocompromised hospitalised patients being particularly at risk. The symptoms range from mild diarrhoea to life-threatening fulminant colitis. We describe an unusual presentation of C. difficile infection after closure of ileostomy in a healthy 60-year-old man with a history of low anterior resection and defunctioning ileostomy for rectal tumour. On the third day postoperatively, the patient developed left lower abdominal pain and profuse diarrhoea. With worsening symptoms and steadily increasing inflammatory markers over the following few days, concerns were raised about an anastomotic leak with pelvic abscess. CT of the abdomen/pelvis on day 7 surprisingly showed colitis in the neorectum/sigmoid colon. A stool test confirmed C. difficile infection.
authors.affiliation: Department of General Surgery, Harrogate District Hospital, Harrogate, UK.
authors.forename: Muhammad Qutayba
authors.initials: MQ
authors.lastname: Almerie
authors.affiliation: Department of Radiology, Harrogate District Hospital, Harrogate, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Culverwell
authors.affiliation: Department of General Surgery, Harrogate District Hospital, Harrogate, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mahon
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000175:diagnosis*; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis* / Q000382:microbiology; D003092:Colitis / Q000175:diagnosis / Q000382:microbiology; D012809:Colon, Sigmoid / Q000382:microbiology / Q000473:pathology; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D012086:Reoperation