A Case Report of Pseudomembranous Colitis with Septic Shock

Hidekazu Sugasawa, Hironori Tsujimoto, Takashi Majima, Kentaro Chochi, Satoshi Ono, Takashi Ichikura, Shinsuke Aida^* and Hidetaka Mochizuki

Department of Surgery I, National Defense Medical College
Department of Laboratory Medicine, National Defense Medical College Hospital*

A 75-year-old woman who underwent an orthopedic operation for lumbar vertebral canal stenosis was admitted to our hospital, because of abdominal distension, severe diarrhea, and developing sepsis. Colonoscopic examination showed a pseudomembrane in the colorectum, and Clostridium difficile toxin A was detected in the pseudomembrane. Vancomycin and metronidazole were administrated via a nasostmach tube and transanal tube for the pseudomembranous colitis, and intensive care for multiple organ dysfunctions were also performed. Because the patient had septic shock as well as developing multiple organ dysfunctions despite appropriate conservative therapy, an emergency laparotomy was carried out. The hugely distended colon with a highly edematous mesocolon was observed, and subtotal colectomy and ileostomy were performed. Immediately after the operation, the patient was recovering from the septic coma and respiratory dysfunction. The patient, however, died from acute respiratory dysfunction and progressive liver dysfunction on the 48 postoperative days. Surgical operation may be recommended as a therapeutic strategy for a pseudomembranous colitis with progressive multiple organ dysfunctions or septic shock.

Key words
pseudomembranous colitis, septic shock, surgical intervention

Reprint requests
Hidekazu Sugasawa Department of Surgery I, National Defense Medical College
3-2 Namiki, Tokorozawa, 359-8513 JAPAN

Accepted
June 22, 2005

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