TERMINAL ILEUM PERFORATION SECONDARY TO Clostridium difficile ENTERITIS

Abstract

Pseudomembranous colitis occurs in patients in whom the normal balance of colonic flora has been disturbed, allowing the overgrow of Clostridium difficile (C. diff). The distribution of pseudomembrane formation is generally restricted to the colon with abrupt termination at the ileocecal valve. Pseudomembrane formation involving the small bowel is extremely unusual. We present two cases of patients with intestinal perforation secondary to C. diff enteritis and compare them with seven cases reported in the literature in the last ten years. Small bowel C. diff enteritis is a rare entity. Presenting symptoms are similar to those of C. diff colitis, but may be more severe, with higher mortality rate. The majority of patients, in this review, were older, with prior gastrointestinal surgery. Although rare, C. diff enteritis should be part of the differential diagnosis in any septic patient with persistent severe diarrhea, despite correct antibiotic therapy and colectomy for C. diff colitis.