Clostridium difficileinfection after ileostomy closure mimicking anastomotic leak

Abstract

Clostridium difficile infection is linked to antibiotic exposure, with elderly and immunocompromised hospitalised patients being particularly at risk. The symptoms range from mild diarrhoea to life-threatening fulminant colitis. We describe an unusual presentation of C. difficile infection after closure of ileostomy in a healthy 60-year-old man with a history of low anterior resection and defunctioning ileostomy for rectal tumour. On the third day postoperatively, the patient developed left lower abdominal pain and profuse diarrhoea. With worsening symptoms and steadily increasing inflammatory markers over the following few days, concerns were raised about an anastomotic leak with pelvic abscess. CT of the abdomen/pelvis on day 7 surprisingly showed colitis in the neorectum/sigmoid colon. A stool test confirmed C. difficile infection.

A systematic review of Clostridium difficile infection following reversal of ileostomy

“…Three papers reported the use of proton pump inhibitors within their study populations [6,10,11]. The mean number of postoperative days to onset of symptoms, where reported, was 6 (range [3][4][5][6][7][8][9][10][11][12][13][14]. Outcomes in the affected patients varied from resolution of symptoms with appropriate antibiotic therapy to death.…”