Pseudomembranous Colitis and Toxic Megacolon

Abstract

The patient was admitted to hospital with a respiratory infection which had been treated with erythromycin. The patient also suffered from bronchiectasis and asthma. Prednisolone and trimethoprim were administered in view of poor lung function. Ten days after admission, there had been no bowel action for 3 days. At the time of the initial surgical consultation, the abdomen was distended with absent bowel sounds. The patient was afebrile with a pulse rate of 110 and a white cell count of 57,400. During the next 4 days, the patient’s bowel function varied from diarrhea to no bowel action or flatus in a 24 hour period. Abdominal distention persisted. Radiological investigation revealed a grossly dilated colon (Figure 64.1) without evidence of mechanical obstruction. The diagnosis remained obscure. On the fifth day of admission, the patient complained of severe abdominal pain in the right upper quadrant. The abdomen was distended with localized tenderness. A computerized tomography (CT) examination revealed a small collection of free gas adjacent to the transverse colon.