Cecal Perforation Associated with Clostridium difficile Infection: A Case Report.
BACKGROUND
Various complications are reported with Clostridium difficile infection (CDI), including fulminant CDI. Fulminant CDI is an underappreciated life-threatening condition associated with complications such as toxic megacolon and bowel perforation.


METHODS
A 79-year-old woman presented to the Emergency Department with altered mental status. She was admitted and conservatively treated for a left thalamic hemorrhage. While hospitalized, she developed watery diarrhea due to Clostridium difficile. Although metronidazole was initiated, she developed altered mental status and septic shock. Abdominal x-ray study and computed tomography revealed a significantly dilatated colon and a massive pneumoperitoneum. She underwent subtotal colectomy with a 14-day course of intravenous meropenem. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case suggests that we must be aware of the complications that CDI may present and adequately consider surgical management because early diagnosis and surgical treatment is critical to reduce the mortality of fulminant CDI.
Department of Anesthesia, Urasoe General Hospital, Okinawa, Japan.
Sarah Kyuragi
SK
Luthe
Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan.
Ryota
R
Sato
D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000472:pathogenicity; D003015:Clostridium Infections / Q000175:diagnosis* / Q000628:therapy*; D003082:Colectomy / Q000379:methods; D003106:Colon / Q000293:injuries* / Q000503:physiopathology; D003244:Consciousness Disorders / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D000077731:Meropenem; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use; D011027:Pneumoperitoneum / Q000209:etiology; D012772:Shock, Septic / Q000209:etiology; D013845:Thienamycins / Q000494:pharmacology / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D008795:Metronidazole; D000077731:Meropenem
Clostridium difficile infection; cecal perforation; complication; fulminant Clostridium difficile infection; toxic megacolon