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At least 19 recordsLinked to original sources
PubMed1998

The role of surgery in pseudomembranous enterocolitis.

Pseudomembranous enterocolitis is an inflammatory bowel disorder caused by Clostridium difficile toxins. Classical presentation includes abdominal pain, pyrexia, diarrhoea and leucocytes. The management is mainly conservative but in extreme cases surgery is necessary. Resectional procedures (colectomy) carry a better prognosis than diversion procedures (colostomy). A careful history, a high index of suspicion, and early diagnosis and treatment would reduce the associated morbidity and mortality of this condition. The aetiopathogenesis, pathology, clinical presentation, diagnosis, differential diagnosis, complications, medical and surgical management are reviewed, and three case reports briefly discussed. A management algorithm is also suggested.

Aged↗
PubMed1976

Subtotal colectomy for refractory pseudomembranous enterocolitis.

Pseudomembranous enterocolitis resulting from therapy with antibiotics such as clindamycin and lincomycin hydrochloride monohydrate does not always respond to drug and vigorous medical support. We describe two seriously ill patients who recovered after subtotal colectomy with ileostomy.

Adult↗
PubMed1977

Pseudomembranous enterocolitis in childhood.

Pseudomembranous enterocolitis is reported in five children. The clinical syndrome, characterized by the acute onset of profuse diarrhea, occurred postoperatively in 2 patients. All the patients had received or were taking antibiotics (penicillin, ampicillin, clindamycin). The disease was severe in 4 persons who presented with hypoproteinemia. Related complications were edema, ascites, pleural effusion, septicemia and/or shock. The diagnosis was made on the basis of typical rectosigmoidoscopic findings. Despite intensive therapy 2 children died. The use of parenteral nutrition is advocated in severe cases with exudative enteropathy. When profuse diarrhea occurs postoperatively or does not rapidly subside with discontinuation of antibiotic therapy, a high index of suspicion should be maintained, even in children, for the possibility of pseudomembranous enterocolitis. An emergency rectosigmoidoscopy should be done in order to make an early diagnosis.

Ampicillin↗
PubMed2003

Prolonged ileus as a sole manifestation of pseudomembranous enterocolitis.

BACKGROUND: Pseudomembranous colitis usually manifests as fever and diarrhea in hospitalized patients treated with systemic antibiotics. We present a case that represents a unique variant. CASE PRESENTATION: The 44-year-old man suffered of several weeks of abdominal pain, low-grade fever, nausea, vomiting, and lack of bowel movements. Upper gastrointestinal barium swallow and passage series revealed evidence of severe intestinal hypomotility. A thorough evaluation for the cause of the patient's ileus and abdominal pain was unrevealing, and symptomatic treatment was ineffective. Following the administration of opiates and dietary fiber supplementation the patient's abdominal pain and distention rapidly worsened, requiring an urgent subtotal colectomy. The macroscopic and microscopic appearance of the excised colon as well as results of the colonic cytotoxin essay and fecal enzyme-linked immunosorbent assay essay confirmed the diagnosis of severe Clostridium difficile induced pseudomembranous colitis as the cause of the patient's illness. CONCLUSION: To our knowledge, this is the first reported case of Clostridium-difficile induced disease consisting of prolonged ileus in the absence of diarrhea in a patient not previously taking antibiotics.

Adult↗
PubMed1994

Pseudomembranous enterocolitis and hemorrhagic necrotizing enterocolitis in Hirschsprung's disease.

From 1977 to 1991, we encountered 67 patients with Hirschsprung's disease and 14 of them developed enterocolitis, with 3 cases being fatal. Enterocolitis occurred preoperatively in 12 infants, as well as after ileostomy in one and after a pull-through procedure in another. Seven infants had severe enterocolitis, including three with pseudomembranous enterocolitis and four with hemorrhagic necrotizing enterocolitis. Enterocolitis in Hirschsprung's disease mainly occurs due to intestinal obstruction and ischemia; however, in some cases, Clostridium difficile overgrowth and its toxin also appears to be related to severe pseudomembranous enterocolitis. In severe enterocolitis, antibiotics and enterostomy often prove to be ineffective, and thus an early resection of the affected bowel appears to be necessary. Moreover, when the aganglionic segment extends to the small bowel, severe enterocolitis tends to occur in the aganglionic intestine even after performing an enterostomy, and a resection of the aganglionic bowel is therefore recommended to allow for adequate lavage of the segment distal to the enterostomy site.

Enterocolitis, Pseudomembranous↗
PubMed1995

Toxic megacolon complicating pseudomembranous enterocolitis.

PURPOSE: Toxic megacolon is a rare complication of pseudomembranous enterocolitis. We reviewed our recent experience with this complication. METHODS: The first five patients of the series were studied retrospectively, and six others were followed prospectively. RESULTS: Between June 1992 and May 1994, 11 patients (8 male, 3 female) developed toxic megacolon secondary to pseudomembranous enterocolitis. Mean age was 60.7 +/- 11.8 (range, 40-79) years. Presenting symptoms and signs included diarrhea, 100 percent; malaise, 91 percent; abdominal pain, 82 percent; abdominal distention, 82 percent; abdominal tenderness, 72 percent; anemia less than 12 gm, 72 percent; albumin less than 3 gm, 64 percent; tachycardia greater than 100, 55 percent; fever greater than 38.5 degrees celsius, 45 percent; shock or hypotension, 45 percent. Predisposing factors included antibiotics, 64 percent; immunosuppressants or chemotherapy, 36 percent; antidiarrheals, 27 percent; and barium enema in one patient. Five patients (45 percent) had more than one predisposing factor. X-rays showed transverse colon dilation and loss of haustrations in eight patients (72 percent), with a mean diameter of 9.9 +/- 3.4 cm. Flexible proctosigmoidoscopy showed pseudomembranes in all scoped patients, and toxin assay for Clostridium difficile was positive in all patients. One patient had emergency surgery. Ten patients were initially treated medically with nasogastric suction and intravenous resuscitation (90 percent) and antibiotics (100 percent), usually in the intensive care unit (80 percent). Four patients did not respond and underwent surgery; two others improved, then deteriorated, and also underwent surgery. Altogether, 7 of 11 patients (64 percent) underwent surgery. Three patients (27 percent) responded well to medical treatment. One patient was deemed too ill to undergo surgery and died. Mean delay to surgery was 3.0 +/- 1.3 days. No sealed or overt perforation was found at laparotomy. All patients who underwent surgery had a subtotal colectomy, with either a Hartmann's stump (71 percent) or a mucous fistula (29 percent). Eventually, five of seven patients who were operated on and two of four medically treated patients died (overall mortality, 64 percent). Only one patient underwent closure of ileostomy and anastomosis. CONCLUSION: Toxic megacolon complicating pseudomembranous enterocolitis is a serious problem that carries a high morbidity and mortality rate, regardless of treatment.

Adult↗
PubMed1981

Pseudomembranous enterocolitis: a historical and clinical review.

Pseudomembranous enterocolitis (PMEC) was first documented in 1893. Since this initial description, confusion has reigned in the medical literature concerning its nature and differentiation from such entities as necrotizing enterocolitis and staphylococcal enterocolitis. Since the 1950s, volumes have been written on PMEC and its association with a multitude of different antibiotics. PMEC has generally been used as somewhat of a "wastebasket" designation, being applied to any postoperative patient who develops significant diarrhea while on broad-spectrum antibiotics. More recently, a resurgence of interest in PMEC has led to its recognition as a specific disease entity and to a greater understanding of its etiology. The current review traces the history of PMEC, distinguishes if from similar disease processes, and describes its clinical presentation, diagnosis, and management. PMEC is particularly distinguished from antibiotic-associated diarrhea and certain forms of antibiotic-associated colitis.

Anti-Bacterial Agents↗
PubMed1976

Drug-induced pseudomembranous enterocolitis: a new etiologic agent.

Pseudomembranous enterocolitis is an iatrogenic illness resulting from the oral or intramuscular use of broad-spectrum antibiotics. It is characterized by diarrhea, mucosal inflammation, and pseudomembrane formation in the gastrointestinal tract. The diagnosis is established by an index of suspicion in individuals who have been on antibiotic therapy, proctosigmoidoscopic examination, stool smears, cultures, and sensitivity. Treatment should be directed to eliminating the etiologic factor and replacing the physiologic abnormality.

Adolescent↗
PubMed1976

Fatal pseudomembranous enterocolitis following clindamycin therapy.

A fatal case of pseudomembranous enterocolitis following oral and parenteral clindamycin therapy is presented. Interesting features in this case are involvement of the small bowel and complete sparing of the large bowel distal to a defunctioning transverse colostomy. The significance of the absence of disease in the defunctioned bowel is discussed in terms of aetiology and diagnosis of pseudomembranous enterocolitis.

Abscess↗
PubMed1979

Pseudomembranous enterocolitis in adults.

Twenty-one patients with pseudomembranous enterocolitis were seen over a 17 year period. Major inciting factors appeared to be an antecedent operation or a serious medical illness. The most common symptoms were fever, diarrhea and abdominal pain. The most commonly involved organ was the colon. The diagnosis was missed in the majority of patients. Neither conservative treatment or surgical treatment were successful. Awareness of the disease and its course will lead to earlier diagnosis and hopefully to a higher cure rate.

Adult↗
PubMed1974

Pseudomembranous enterocolitis. Resurgence related to newer antibiotic therapy.

Six patients with pseudomembranous entercolitis were seen at one institution over a six-month period. Clindamycin therapy preceded the diagnosis in all six patients and possibly caused the disease in five cases. Common clinical features included diarrhea, abdominal pain, fever, leukocytosis, radiographic findings of large bowel dilatation with mucosal thickening and a characteristic sigmoidoscopic or gross pathologic demonstration of discrete yellow-white plaques on an otherwise normal mucosa. Complications included toxic megacolon and sigmoid colon perforation. Two of the six patients died. The literature since 1970 is tabulated to clarify the clinical and pathological features of pseudomembranous enterocolitis associated with newer antibiotic therapy. Lincomycin and clindamycin are strongly implicated in the recent resurgence of this formerly rare variety of colitis.

Adult↗
PubMed1990

Pseudomembranous enterocolitis--a potentially lethal disease.

The cases of nine children with pseudomembranous enterocolitis, five of whom died, are reported here. Six had prior antibiotic therapy, and in eight there were other diseases present that were considered to contribute to the development of this disease. Awareness of this condition, which requires aggressive medical and surgical management, is discussed.

Child↗