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Toxic megacolon — unusual complication of pseudomembranous colitis

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Abstract

Pseudomembranous colitis (PMC) is a severe inflammatory disease process that affects the gastrointestinal tract. It was first described as a postoperative complication by Finney1 in 1893. The name is derived from a thick tenacious membrane that coats the lumen of the bowel and consists of fibrin, leukocytes, and microorganisms. The severity of the illness varies from mild and clinically undetected to fulminating and fatal.

Rarely will PMC have presenting symptoms or simulate toxic megacolon. An experience with two fatal postoperative cases has prompted this report and a review of previously published cases (Table).

Case reports

Case 1. A 69-year-old woman with a rectosigmoid tumor was admitted to the Cleveland Clinic Hospital on September 3, 1975. The preoperative proctoscopic biopsy specimen of this lesion revealed atypical cells. Results of physical examination and all laboratory tests (complete blood count, SMA-12, SMA-6, ECG, chest roentgenogram, spirometry, and arterial blood gases) were normal. At surgery a Meckel's diverticulum and benign sessile polypoid lesion of the colon were excised. Postoperatively, her progress was satisfactory until a symptomatic urinary tract infection (enterococcus, 100,000 colonies/ml) developed on the sixth postoperative day; the infection was treated with ampicillin, 500 mg orally, four times a day for 6 days.

On the 12th postoperative day, loose, watery green stools were passed, a rectal temperature of 101F and white blood cell count (WBC) of 21,600 mm3 were recorded. Ampicillin was discontinued. A Gram stain and stool culture for aerobic and anaerobic bacteria revealed normal flora. Treatment was symptomatic and consisted of . .


 

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