Fulminant <i>Clostridium difficile</i> Colitis Successfully Treated by Left Hemicolectomy

DOI Web Site 2 Citations 21 References Open Access
  • Maeda Shingo
    Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  • Yuasa Norihiro
    Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  • Takeuchi Eiji
    Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  • Goto Yasutomo
    Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  • Miyake Hideo
    Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  • Nagai Hidemasa
    Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  • Yoshioka Yuichiro
    Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  • Okuno Masataka
    Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  • Miyata Kanji
    Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya Daiichi Hospital
  • Fujino Masahiko
    Department of Cytology and Molecular Pathology, Japanese Red Cross Nagoya Daiichi Hospital

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  • 結腸左半切除にて救命しえた劇症型<i>Clostridium difficile</i>腸炎の1例

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<p>An 85-year-old woman visited our hospital with a history of abdominal pain and watery diarrhea. She had not been treated or given antibiotics for any other disease during the 3 months since the onset of the symptoms. Fecal test using rapid enzyme immunoassay showed positive results for glutamate dehydrogenase (GDH) antigen and negative for Clostridium difficile (CD) toxin, on the basis of which we diagnosed infectious enteritis. On the fourth day after admission, she developed severe abdominal pain, and CT revealed abdominal free air. In addition, bacterial culture of the feces obtained on admission revealed CD, and the result of the rapid test using enzyme immunoassay of the CD colony became positive for CD toxin. Thus, a colonic perforation due to CD colitis was diagnosed, following which an emergency surgery was performed. Laparotomy revealed perforations in the sigmoid colon and deteriorated color of the descending and sigmoid colon; therefore, left hemicolectomy and transverse colostomy were performed. Fulminant CD colitis can occur in the absence of history of treatment for any other disease or prior administration of antibiotics. Treatment of CD colitis should be initiated when investigations yield positive results for fecal GDH antigen and when CD colitis is suspected according to the clinical presentation.</p>

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