Clostridium difficile infection secondary to ileostomy closure

Abstract

Protective ileostomy may be a risk factor for the development of Clostridium difficile (CD) infection (CDI). In the postoperative period signs of CDI may be particularly difficult to differentiate from intra-abdominal sepsis. Presented here are 2 cases that developed CDI after ileostomy reversal. Two patients who underwent low anterior resections after neoadjuvant chemoradiation with protective ileostomy developed fever, leukocytosis and elevated serum C-reactive protein (CRP) levels. The first patient also had negative CD stool toxins and his signs were so severe that he underwent a negative diagnostic laparoscopy and re-creation of ileostomy. The second patient who presented in a similar fashion was more fortunate in that her CD stool toxin was positive and she was treated successfully with oral vancomycin. CDI after ileostomy reversal after low anterior resection can be difficult to diagnose. In the first patient, the situation was so misleading that diagnostic laparoscopy was required. Outcome was eventually favorable in both cases. CDI must be high on the list of differential diagnoses for febrile patients with a leukocytosis and elevated CRP level even in the setting of negative CD stool toxins. Prophylactic intravenous metronidazole and/or vancomycin enemas should be considered prior to colorectal surgery when a protective ileostomy is likely.

A Rare Culture-Negative Ascites Induced by Clostridium Difficile in a Patient with End-Stage Renal Disease: A Case Report and Literature Review

“…A literature review for ascites induced by Clostridium Difficile Infection (CDI) yielded 16 patients in 12 case reports, Table 2 [3][4][5][6][7][8][9][10][11][12][13][14]. Previous history of antibiotic was mentioned in 12 patients [3][4][5]9,[11][12][13][14].…”

“…A literature review for ascites induced by Clostridium Difficile Infection (CDI) yielded 16 patients in 12 case reports, Table 2 [3][4][5][6][7][8][9][10][11][12][13][14]. Previous history of antibiotic was mentioned in 12 patients [3][4][5]9,[11][12][13][14]. Culture-Negative Neutrocytic Ascites (CNNA) was reported in all patients except 3 cases, two of them had culture-positive ascites after abdominal interventions and ascites culture was not performed in the third case [7,8,12].…”