A Case of Peritonitis Caused by Fulminant Pseudomembranous Colitis Requiring Subtotal Colectomy

Tokoro Tadao, Okuno Kiyotaka, Hida Jin-ichi, Ishimaru Eizaburo, Ueda Kazuki, Yoshifuji Takehito, Hattori Takashi, Takemoto Masako, Sugiura Fumiaki

doi:10.3862/jcoloproctology.62.44

A 69-year-old man was brought to our hospital for treatment of systemic lupus erythematosus and gastrointestinal tract bleeding. He had previously undergone argon plasma coagulation treatment for telangiectasia of the stomach and was receiving intravenous hyperalimentation. After administration of antibiotics and antimycotic agent for catheter fever, diarrhea and abdominal pain developed. Clostridium difficile-associated colitis was identified from fecal examination, so oral vancomycin was immediately administered. After 4 days, he underwent emergency subtotal colectomy due to aggravation of distended abdomen and peritonitis with shock. A surgical specimen showed pseudomembranous colitis (PMC), which had produced a pseudomembrane over the entire colon mucosa. Despite postoperative intensive care, the patient died 27 days later. Autopsy revealed that the cause of death was systemic mucormicosis.<br> Patients with PMC can be cured by conservative therapy in most cases, but delayed diagnosis may necessitate surgical intervention for a severe state. These patients often present with unexplained abdominal illness with marked leukocytosis that rapidly progresses to shock and peritonitis. Mortality from fulminant PMC remains high under the requirement for vasopressors or immunosuppressive condition. Rapid diagnosis and treatment are crucial for positive outcomes, and early surgical intervention should be used in medically unresponsive patients.<br>

A Case of Peritonitis Caused by Fulminant Pseudomembranous Colitis Requiring Subtotal Colectomy

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