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Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.In general, authors of case reports should use the Brief Report format. Clostridium difficile Pouchitis after Proctocolectomy with Ileal Pouch-Anal AnastomosisClostridium difficile infections of the large intestine are thought to occur as a result of an imbalance of colonic flora from antibiotic or proton pump inhibitor use. However, in recent years, there have been reports of C. difficile-associated infections of the small intestine, particularly after colectomy, often with fulminant clinical courses and mortality rates as high as 60 to 83 per cent. 1 Patients with inflammatory bowel disease may be more prone to develop C. difficile infection. 2 C. difficile enteritis several months after restorative proctocolectomy has also been reported as an unusual cause of pouchitis. 3 We present a unique case of a patient who developed C. difficile enteritis as well as pouchitis in the immediate postoperative course after restorative proctocolectomy and ileal pouch-anal anastomosis.An 18-year-old man with refractory ulcerative colitis (UC) was referred to our center for consideration of surgical intervention in September 2006. He had been diagnosed at age 14 years and had undergone several colonoscopies with histologic confirmation of the diagnosis of UC. He had no other medical problems. However, he had persistent diarrhea despite medical treatment and, 6 weeks before the procedure, developed worsening symptoms. He was evaluated by his gastroenterologist, had a negative infectious diarrhea work-up, and was then referred for surgical consultation. The patient was on very low-dose oral prednisone preoperatively and had not been treated with biologics. He underwent a restorative proctocolectomy with ileal pouch-anal anastomosis as a single-stage procedure without a temporary ileostomy. The procedure was uneventful.

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