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Clostridium difficile enteritis: an early postoperative complication in inflammatory bowel disease patients after colectomy. J Gastrointest Surg 2007 Feb;11(2):138-42 PMID: 17390162

Pubmed ID

17390162

Abstract

Clostridium difficile, the leading cause of hospital-acquired diarrhea, is known to cause severe colitis. C. difficile small bowel enteritis is rare (14 case reports) with mortality rates ranging from 60 to 83%. C. difficile has increased in incidence particularly among patients with inflammatory bowel disease. This case series of six patients from 2004 to 2006 is the largest in the literature. All patients received antibiotics before colectomies for ulcerative colitis and developed severe enteritis that was C. difficile toxin positive. Three patients underwent ileal pouch anal anastomosis and loop ileostomy. Four of the six patients had C. difficile colitis before colectomy. Presenting symptoms were high volume watery ileostomy output followed by ileus in five of six patients. Four of the six patients presented with fever and elevated WBC. Five of the six developed complications requiring further surgery or prolonged hospitalization. Patients were treated with intravenous hydration and metronidazole then converted to oral metronidazole and/or vancomycin. None of the patients died. A high suspicion of C. difficile enteritis in patients with inflammatory bowel disease and history of C. difficile colitis may lead to more rapid diagnosis, aggressive treatment, and improved outcomes for patients with C. difficile enteritis.

Author List

Lundeen SJ, Otterson MF, Binion DG, Carman ET, Peppard WJ

Authors

Sarah J. Lundeen NP Nurse Practitioner Surgical in the Surgery department at Medical College of Wisconsin
Mary F. Otterson MD Professor in the Surgery department at Medical College of Wisconsin
William J. Peppard PharmD Trauma/Surgical Critical Care Pharmacist in the Pharmacy department at Froedtert Hospital




Scopus

2-s2.0-34548442485   61 Citations

MESH terms used to index this publication - Major topics in bold

Adult
Clostridium Infections
Clostridium difficile
Colectomy
Cross Infection
Enteritis
Humans
Inflammatory Bowel Diseases
Middle Aged
Postoperative Complications
jenkins-FCD Prod-300 626508253d14e4184314fb9f66322a03a5906796