Pseudomembranous colitis - Example 2
Author: Prof. em. Dr. med. S. Liebe, University Hospital Rostock, Rostock, Germany
From: Falk Media Service D34, Endoscopy Practice on Video - Selected Diseases of the Colon
2. Edition 2012. © Falk Foundation e.V. All rights reserved.
This 62-year-old white male underwent a successful kidney transplantation 2 years ago. Acute diarrhea was initially treated with antibiotics. The patient, however, did not recover but his condition became worse, with diarrhea, fever, exhaustion and exsiccosis. The severely ill patient was admitted to in-patient hospitalization with distended abdomen, severe abdominal pain, reduced bowel sounds and very high CRP. Endoscopy was performed with the putative diagnosis of pseudomembranous colitis.
The video starts at about the transverse colon. Bizarre yellowish pseudomembranes can be seen to completely fill the bowel lumen with mucus. The bowel wall is completely hidden in these areas. In more distal areas, small areas of bowel mucosa are seen and the pseudomembranes in these areas are partially represented by individual plaques. There are also small areas of mucosa with normal vasculature.
Endoscopy reveals a typical picture of pseudomembranous colitis. The disease course was very severe in this patient and there was danger of perforation or development of toxic megacolon. In such cases, the decision between conservative management and surgery must be constantly re-evaluated. Colonoscopy should be performed with utmost caution and only to the extent necessary to confirm the diagnosis. High colonoscopy is not required and should be avoided because of the danger of perforation.
(see also commentary to Example 1)