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Pseudomembranous enterocolitis resulting from therapy with antibiotics such as clindamycin and lincomycin hydrochloride monohydrate does not always respond to drug and vigorous medical support. We describe two seriously ill patients who recovered after subtotal colectomy with ileostomy.
Pseudomembranous enterocolitis is reported in five children. The clinical syndrome, characterized by the acute onset of profuse diarrhea, occurred postoperatively in 2 patients. All the patients had received or were taking antibiotics (penicillin, ampicillin, clindamycin). The disease was severe in 4 persons who presented with hypoproteinemia. Related complications were edema, ascites, pleural effusion, septicemia and/or shock. The diagnosis was made on the basis of typical rectosigmoidoscopic findings. Despite intensive therapy 2 children died. The use of parenteral nutrition is advocated in severe cases with exudative enteropathy. When profuse diarrhea occurs postoperatively or does not rapidly subside with discontinuation of antibiotic therapy, a high index of suspicion should be maintained, even in children, for the possibility of pseudomembranous enterocolitis. An emergency rectosigmoidoscopy should be done in order to make an early diagnosis.
A case of fatal pseudomembranous enterocolitis associated with ampicillin therapy is described and possible mechanisms for its production discussed.
Twenty-one patients with pseudomembranous enterocolitis were seen over a 17 year period. Major inciting factors appeared to be an antecedent operation or a serious medical illness. The most common symptoms were fever, diarrhea and abdominal pain. The most commonly involved organ was the colon. The diagnosis was missed in the majority of patients. Neither conservative treatment or surgical treatment were successful. Awareness of the disease and its course will lead to earlier diagnosis and hopefully to a higher cure rate.
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The hemolytic-uremic syndrome consists of hemolytic anemia, renal failure, and thrombocytopenia. Submucosal hemorrhage with "thumbprinting" on roentgenographic examination of the colon with barium was demonstrated in four patients, prolapse of the rectum in two patients, and pseudomembranous enterocolitis and toxic megacolon in one. These lesions are not generally associated with hemolytic-uremic syndrome. The presence of these lesions in a child with bloody diarrhea should suggest hemolytic-uremic syndrome as a possible diagnosis. Sigmoidoscopy and roentgenographic examination of the colon with barium should be done in selected patients with hemolytic-uremic syndrome to evaluate the degree of colonic involvement and the need for surgery.
Seven elderly cases with reversible electrocardiographic changes simulating acute myocardial infarction in the absence of gross myocardial infarction on postmortem examination were observed following the blood transfusion. The underlying diseases were cancer of gastrointestinal tract or gall bladder in 4, gastric ulcer in 2, and 1 of pseudomembranous enterocolitis. The electrocardiogram revealed the abnormal Q waves with monophasic ST elevation and following coronary T inversion. These findings lasted only for 2 to 7 days and returned to the previous normal tracings. The hematocrit was elevated from 28.9 to 47.7 after the blood transfusion of 800 to 1,800 ml. The disseminated intravascular coagulation was shown in 5 cases. GOT levels were within normal ranges except 1 case. Pathological findings in cases with recent electrocardiographic changes were characterized by the mural thromboses, extending into the myocardium through the Thebesian vein. The focal small necroses of the adjacent myocardium or around the thrombosis of small vessels were also observed. In the later phase the fine interstitial fibrosis took place after the resorption of the thrombi and necrotic foci. From these clinical and pathological findings we proposed a new concept of reversible myocardial infarction induced from the hypercoagulability, disseminated intravascular coagulation, and elevated hematocrit.
The term inflammatory bowel disease (IBD) is viewed as all-inclusive, covering the full panoply of intestinal disorders in which inflammatory changes are a prominent feature, including those of infectious, toxic, and intrinsic origin as well as the idiopathic entities ulcerative colitis and Crohn's disease. This chapter describes and discusses those aspects of colo-rectal biopsy in IBD which can help pathologists make optimal interpretations. The areas covered are: 1) methods used to prepare biopsy specimens for study, 2) normal histologic findings and common artefacts, 3) basic pathologic changes occurring in IBD, 4) a general approach to differential diagnosis in IBD, and 5) discussion of the various individual forms of IBD. The importance of full and reliable information exchange between the endoscopist and pathologist is stressed. Special attention is given to features in biopsy specimens which help in differentiating between ulcerative colitis and Crohn's disease. Other entities discussed are bacterial dysenteries; gonococcal proctitis; tuberculosis; Whipple's disease; amebiasis; balantidiasis; schistosomiasis; cryptosporidiosis; lymphopathia venereum; cytomegalovirus infection; histoplasmosis; antibiotic colitis; IBD due to cytotoxic drugs (5-FU), heavy metals, and foodstuffs; irradiation colitis; ischemic colitis; solitary ulcer syndrome; diverticulitis; and colitis secondary to obstruction. The term pseudomembranous enterocolitis is also considered.