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Fulminant Clostridium difficile-associated pouchitis with a fatal outcome

Nature Reviews Gastroenterology & Hepatology volume 6, pages 492–495 (2009)Cite this article

Abstract

Background. A 61-year-old woman who had undergone an ileostomy closure 10 days previously presented to a tertiary medical center with abdominal pain, vomiting, diarrhea, dehydration, and oliguria. The patient had undergone a staged total proctocolectomy with ileal-pouch–anal anastomosis and a loop ileostomy 8 months previously to treat her steroid-refractory ulcerative colitis.

Investigations. Physical examination, abdominal and pelvic CT scan, blood laboratory tests, pouch endoscopy, and fecal testing for Clostridium difficle toxins A and B.

Diagnosis. Fulminant C. difficile-associated pouchitis and enteritis, which led to Psuedomonas aeruginosa septicemia, intravascular coagulopathy, acute renal failure, hemorrhagic ascites and respiratory failure and eventual death.

Management. Intravenous hydration, aggressive therapy with oral and intravenous antibiotics, supportive care, hemodialysis, and intubation.

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Acknowledgements

Written consent for publication was obtained from the patient's responsible relative.

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Author notes

  1. B. Shen, Digestive Disease Institute-Desk A30, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA shenb@ccf.org

Authors and Affiliations

  1. Digestive Disease Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Bo Shen, Feza H. Remzi & Victor W. Fazio

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Shen, B., Remzi, F. & Fazio, V. Fulminant Clostridium difficile-associated pouchitis with a fatal outcome. Nat Rev Gastroenterol Hepatol 6, 492–495 (2009). https://doi.org/10.1038/nrgastro.2009.105

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