A Case of Clostridium Difficile Enterocolitis Succsessfully Treated with Vancomycin Administered Via Long Intestinal Tube
We report a case of Clostridium difficile (CD) enterocolitis succsessfully treated with vancomycin (VCM) administered via long intestinal tube. An 82-year-old man was refer to the hospital because of obstructive jaundice. He was diagnosed as hilar cholangiocarcinoma by endoscopic retrograde cholangi...
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| Published in | The Japanese Journal of Gastroenterological Surgery Vol. 35; no. 1; pp. 92 - 96 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Society of Gastroenterological Surgery
2002
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.35.92 |
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| Abstract | We report a case of Clostridium difficile (CD) enterocolitis succsessfully treated with vancomycin (VCM) administered via long intestinal tube. An 82-year-old man was refer to the hospital because of obstructive jaundice. He was diagnosed as hilar cholangiocarcinoma by endoscopic retrograde cholangiography. For acute obstructive suppurative cholangitis, we attempted percutaneous transhepatic bile duct drainage, but failed, necessitating a laparotomy for drainage. RTBD tubes were inserted into the left and right hepatic ducts through the stricture of the hilar bile duct and bile juice was drained extracorporally. On postoperative day 8, excessive diarrhea was observed and toxin A of CD was positive from stool specimens. Oral VCM (2.0g/day) was started, but severe abdominal pain and distension occurred 4 days thereafter. Abdominal X-ray showed paralytic ileus. We inserted a long intestinal tube to administer. The man's condition improved dramatically the next day, and the tube was removed after 6 days. Oral administration with VCM is effective in treating CD enterocolitis, but in paralytic ileus, orally administered VCM does not reach the site of interstinal inflammation, long intestinal tube may thus present a viable alternative in refractory CD enterocolitis. |
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| AbstractList | We report a case of Clostridium difficile (CD) enterocolitis succsessfully treated with vancomycin (VCM) administered via long intestinal tube. An 82-year-old man was refer to the hospital because of obstructive jaundice. He was diagnosed as hilar cholangiocarcinoma by endoscopic retrograde cholangiography. For acute obstructive suppurative cholangitis, we attempted percutaneous transhepatic bile duct drainage, but failed, necessitating a laparotomy for drainage. RTBD tubes were inserted into the left and right hepatic ducts through the stricture of the hilar bile duct and bile juice was drained extracorporally. On postoperative day 8, excessive diarrhea was observed and toxin A of CD was positive from stool specimens. Oral VCM (2.0g/day) was started, but severe abdominal pain and distension occurred 4 days thereafter. Abdominal X-ray showed paralytic ileus. We inserted a long intestinal tube to administer. The man's condition improved dramatically the next day, and the tube was removed after 6 days. Oral administration with VCM is effective in treating CD enterocolitis, but in paralytic ileus, orally administered VCM does not reach the site of interstinal inflammation, long intestinal tube may thus present a viable alternative in refractory CD enterocolitis. |
| Author | Tabata, Tomotake Sato, Taichiro Moriura, Shigeaki Matsumoto, Takatoshi Ishiguro, Seiji Kobayasi, Ichiro |
| Author_xml | – sequence: 1 fullname: Ishiguro, Seiji organization: Department of Surgery, Yachiyo Hospital – sequence: 1 fullname: Kobayasi, Ichiro organization: Department of Surgery, Yachiyo Hospital – sequence: 1 fullname: Matsumoto, Takatoshi organization: Department of Surgery, Yachiyo Hospital – sequence: 1 fullname: Moriura, Shigeaki organization: Department of Surgery, Yachiyo Hospital – sequence: 1 fullname: Tabata, Tomotake organization: Department of Surgery, Yachiyo Hospital – sequence: 1 fullname: Sato, Taichiro organization: Department of Surgery, Yachiyo Hospital |
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| References | 5) Gerding DN: Treatment of Clostridium difficileassociated diarrhea and colitis. Curr Top Microbiol Immunol 250: 127-139, 2000 4) 石郷潮美, 浅野裕子, 入山純司ほか: 試薬及び及び試験機器の検討Clostridium difficile性下痢症腸炎における迅速診断用ToxinA検出キットの有用性. 臨と微生物26: 867-869, 1999 6) Fekety R: Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 92: 739-750, 1997 14) Tsutaoka B, Hansen J, Johnson D et al: Antibioticassociated pseudomembranous enteritis due to Clostridium difficile. Clin Infect Dis 18: 982-984, 1994 1) Gorenek L, Dizer U, Besirbellioglu B et al: The diagnosis and treatment of Clostridium difficile in antibiotic-associated diarrhea. Hepatogastroenterology 25: 343-348, 1999 13) Olson MM, Shanholtzer CJ, Lee JT et al: Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infect Control Hosp Epidemiol 15: 371-381, 1994 10) Triadafilopoulos G, Hallstone AE, Acute abdomen as the first presentation of pseudomembranous colitis. Gastroenterology 101: 685-691, 1991 11) Trudel JL, Deschenes M, Mayrand S: Toxicmegacolon complicating pseudomembranous enteocolitis. Dis Colon Rectum 38: 1033-1038, 1995 7) Teasley DG, Gerding DN, Olson MM et al: Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet 2: 1043-1046, 1983 9) Fekety R, Silva J. Kauffman C et al: Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens. Am J Med 86: 15-19, 1989 2) Cleary RK: Clostridium difficile-associated diarrhea and colitis: clinical manifestations, diagnosis, and treatment. Dis Colon Rectum 41: 1435-1449, 1998 8) Wenisch C, Parschalk B, Hasenhundl M et al: Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea. Clin Infect Dis 22: 813-818, 1996 15) Silva J Jr: Update on pseudomembranous colitis. West J Med 151: 644-648, 1989 3) Gerding DN, Olson MM, Peterson LR et al: Clostridium difficile-associated diarrhea and colitis in adults. A prospective case-controlled epidemiologic study. Arch Intern Med 146: 95-100, 1986 12) Lipsett PA, Samantaray DK, Tam ML et al: Pseudomembranous colitis: a surgical disease ? Surgery 116: 491-496, 1994 16) Ledeboer M, Masclee AA, Coenraad M et al: Antroduodenal motility and small bowel transit during continuous intraduodenal or intragastric administration of enteral nutrition. Eur J Clin Invest 29: 615-623, 1999 |
| References_xml | – reference: 13) Olson MM, Shanholtzer CJ, Lee JT et al: Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infect Control Hosp Epidemiol 15: 371-381, 1994 – reference: 10) Triadafilopoulos G, Hallstone AE, Acute abdomen as the first presentation of pseudomembranous colitis. Gastroenterology 101: 685-691, 1991 – reference: 11) Trudel JL, Deschenes M, Mayrand S: Toxicmegacolon complicating pseudomembranous enteocolitis. Dis Colon Rectum 38: 1033-1038, 1995 – reference: 3) Gerding DN, Olson MM, Peterson LR et al: Clostridium difficile-associated diarrhea and colitis in adults. A prospective case-controlled epidemiologic study. Arch Intern Med 146: 95-100, 1986 – reference: 15) Silva J Jr: Update on pseudomembranous colitis. West J Med 151: 644-648, 1989 – reference: 6) Fekety R: Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 92: 739-750, 1997 – reference: 12) Lipsett PA, Samantaray DK, Tam ML et al: Pseudomembranous colitis: a surgical disease ? Surgery 116: 491-496, 1994 – reference: 14) Tsutaoka B, Hansen J, Johnson D et al: Antibioticassociated pseudomembranous enteritis due to Clostridium difficile. Clin Infect Dis 18: 982-984, 1994 – reference: 9) Fekety R, Silva J. Kauffman C et al: Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens. Am J Med 86: 15-19, 1989 – reference: 1) Gorenek L, Dizer U, Besirbellioglu B et al: The diagnosis and treatment of Clostridium difficile in antibiotic-associated diarrhea. Hepatogastroenterology 25: 343-348, 1999 – reference: 2) Cleary RK: Clostridium difficile-associated diarrhea and colitis: clinical manifestations, diagnosis, and treatment. Dis Colon Rectum 41: 1435-1449, 1998 – reference: 8) Wenisch C, Parschalk B, Hasenhundl M et al: Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea. Clin Infect Dis 22: 813-818, 1996 – reference: 4) 石郷潮美, 浅野裕子, 入山純司ほか: 試薬及び及び試験機器の検討Clostridium difficile性下痢症腸炎における迅速診断用ToxinA検出キットの有用性. 臨と微生物26: 867-869, 1999 – reference: 16) Ledeboer M, Masclee AA, Coenraad M et al: Antroduodenal motility and small bowel transit during continuous intraduodenal or intragastric administration of enteral nutrition. Eur J Clin Invest 29: 615-623, 1999 – reference: 5) Gerding DN: Treatment of Clostridium difficileassociated diarrhea and colitis. Curr Top Microbiol Immunol 250: 127-139, 2000 – reference: 7) Teasley DG, Gerding DN, Olson MM et al: Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet 2: 1043-1046, 1983 |
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| Title | A Case of Clostridium Difficile Enterocolitis Succsessfully Treated with Vancomycin Administered Via Long Intestinal Tube |
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