Журнал "Гастроэнтерология" Том 55, №2, 2021
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Acute Toxic Megacolon as a Complication of Pseudomembranous Colitis
Авторы: V.V. Kernychnyi, B.E. Li
Faculty of Postgraduate Education, Vinnytsya
National Pirogov Memorial Medical University, Khmelnytskyi, Ukraine
Рубрики: Гастроэнтерология
Разделы: Медицинские форумы
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The purpose of the study: demonstration of a clinical case of acute toxic dilation of the colon as a complication of the fulminant form of pseudomembranous colitis.
Materials and methods. Аnalysis of the medical records of patient P., who was treated in the proctology department of the Khmelnytskyi Regional Hospital.
Results. Patient P., 63 years old, hospitalized in serious condition with confused consciousness, disoriented. From the anamnesis — became acutely ill, on the eve he had been having an increase in body temperature to 37.3 °C for 2 days. Based on the data of physical and instrumental examination, the diagnosis was made: bilateral polysegmental pneumonia, moderate hydrothorax. PCR testing for SARS-CoV-2 virus RNA was performed twice — results were negative. Intensive infusion and antibacterial therapy were started, after which the patient's condition improved. On the 8th day there was a sharp deterioration of the patient's condition — severe abdominal pain, bloating, diarrhea up to 12 times a day. After additional examination, pseudomembranous colitis was diagnosed and complex conservative therapy was started. Despite conservative treatment, the patient’s condition gradually deteriorated — increased general intoxication, defecation up to 20 times a day, no peristalsis, weakly positive signs of peritoneal irritation. An X-ray of the abdominal organs was performed, and a sharply pancolonic dilatation (up to 12–15 cm) was found. The diagnosis of acute toxic dilatation of the colon secondary to pseudomembranous colitis was made and the decision was to perform emergency surgery. Obstructive subtotal colectomy with a Brooke ileostomy was performed. Intraoperative picture and histopathological conclusion confirmed the diagnosis. On day 3 after surgery, antibacterial therapy was canceled and enteral nutrition was initiated. On postoperative day 8, the patient was discharged from the hospital in satisfactory condition.
Conclusions. Pseudomembranous colitis associated with Clostridium difficile is a severe consequence of using antibiotics. Over the past decade, there has been a rise of the incidence of pseudomembranous colitis. Toxic megacolon is a rare and extremely severe, irreversible, disabling complication of pseudomembranous colitis, which requires emergency surgical intervention, delay with which leads to severe systemic intoxication, exhaustion of the patient and fatal outcomes. Obstructive total/subtotal colectomy is the only recommended surgical intervention that associated with positive prognosis for the patient’s life.