Pseudomembranous Enterocolitis

An acute inflammation and necrosis of the small and large intestines, pseudomembranous enterocolitis usually affects the mucosa but may extend into submucosa and, rarely, other layers. Marked by severe diarrhea, this rare condition is generally fatal in 1 to 7 days from severe dehydration and from toxiCity, pentomtls, or perforation.

Causes

Pseudomembranous enterocolitis is thought to be caused by a change in the flora of the colon and an overgrowth of a toxin-producing strain of Clostridium difficile.

Pseudomembranous enterocolitis has occurred postoperatively in debilitated patients who undergo abdominal surgery or patients who have been treated with broad-spectrum antibiotics. Ampicillin, clindamycin, and cephalosporins are suspected as causative factors. Immunocompromised patients (such as individuals with cystic fibrosis, neurologic disease, liver and renal disease, diabetes mellitus, malnutrition, and hematologic disorders) are at increased risk for this disease. Whatever the cause, necrosed mucosa is replaced by a pseudomembrane filled with staphylococci, leukocytes, mucus, fibrin, and inflammatory cells.

Signs and symptoms

Pseudomembranous enterocolitis begins suddenly with copious watery diarrhea, abdominal pain, and fever. Diarrhea, with or without blood, and abdominal pain may occur within 48 hours after administration of the drug. Signs and symptoms may begin with mild to moderate watery diarrhea with lower abdominal cramping. As the disease progresses, the patient may have profuse watery diarrhea with up to 30 stools per day and abdominal pain. Low-grade fever, along with abdominal tenderness and leukocytosis, occurs.

Diagnosis

Treatment

A patient who is receiving broad-spectrum antibiotic therapy requires immediate discontinuation of the antibiotics. If possible, medications that slow peristalsis should be avoided. Effective treatment usually includes orally administered metronidazole (250 mg). Oral vancomycin is usually given for severe or resistant cases, but this is costly.

Supportive treatment must maintain fluid and electrolyte balance and combat hypotension and shock with pressors, such as dopamine and levarterenol.