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Pseudomembranous Enterocolitis

Pseudomembranous enterocolitis is an acute inflammation and necrosis of the small and large intestines. It usually affects the mucosa but may extend into the submucosa and, rarely, other layers. This rare condition, marked by severe diarrhea, can be fatal in 1 to 7 days from severe dehydration and from toxicity, peritonitis, or perforation.

Causes

Infection from bacteria, usually Clostridium difficile, which manufactures a toxin that causes the symptoms; or from the staphylococcus germ. These germs normally inhabit the intestinal tract. They cause enterocolitis when other normal bacterial of the intestinal tract have been killed by heavy use of broad-spectrum antibiotics. This upsets the bacterial balance of the intestinal tract. The illness usually occurs as a complication of surgery.

Signs and Symptoms

The patient's history usually reveals current or recent antibiotic treatment. Typically, the patient reports the sudden onset of copious, watery or, rarely, bloody diarrhea; abdominal pain; and fever. Palpation may reveal abdominal tenderness.

Careful consideration of the patient's history is essential because the abrupt onset of enterocolitis and the emergency situation it creates can make diagnosis difficult.

Diagnostic tests

A rectal biopsy through sigmoidoscopy confirms pseudomembranous enterocolitis. Stool cultures can be used to identify C. difficile.

Treatment

If the patient is receiving broad-spectrum antibiotic treatment, the first priority is immediate discontinuation of the offending drug. Usually, the patient is then treated with oral metronidazole or oral vancomycin. Metronidazole generally is used first; if it's ineffective, vancomycin is given.

Supportive treatments include maintaining fluid and electrolyte balance and combatting hypotension and shock with vasopressors, such as dopamine and norepinephrine.



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