Pseudomembranous colitis - Example 1
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 68-year-old white male experienced diarrhea, exhaustion and slight fever following a course of antibiotic treatment with a cephalosporin for suppurative bronchitis. Because of his reduced general health, the patient was admitted to in-patient hospitalisation.
The video shows severe pseudomembranous colitis of the sigmoid and descending colon. There are round, elevated plaques, mostly yellow in color, adhering to inflamed mucosa. At places, the plaques coalesce. At a few places, the pseudomembranes fill the lumen of the bowel. There is significant production of mucus.
Endoscopy reveals a typical picture of pseudomembranous colitis, which is full-blown and recognizable at sight. In less severe cases, the plaques are individual and the surrounding mucosa may exhibit normal vasculature. In more severe cases, the plaques coalesce and may cover the entire wall of the colon, such that the colonic lumen may appear narrowed by a whitish-yellow mucous mass. The disease can affect the entire colon, but most commonly affects the rectum and sigmoid colon. If a macroscopic diagnosis is possible based on examination of the rectum or sigmoid, a high colonoscopy, because of the danger of perforation in severe cases, is not necessary.
Pseudomembranous enterocolitis may develop in connection with antibiotic treatment or in immunosuppressed patients. Most commonly, patients have undergone treatment with a cephalosporin, clindamycin, ampicillin or amoxicillin, although the disease has also been reported in connection with many other antibiotics. The cause is a change in the normal intestinal flora, which no longer checks overgrowth of toxin-producing Clostridium difficile species. Clinical symptoms range from watery diarrhea to the most severe clinical pictures with fever, leukocytosis, electrolyte imbalances and dehydration. Colitis may progress to perforation or toxic megacolon.