Clostridium difficile colitis mimicking acute peritonitis
M. S. Drapkin, M. G. Worthington, T. W. Chang and S. A. Razvi
Five patients receiving penicillin V potassium or a cephalosporin
antibiotic for 18 hours to 22 days developed fever, marked leukocytosis,
and signs and symptoms that suggested right-lower-quadrant peritoneal
irritation. All underwent emergency laparotomy, at which dilatation and
inflammation of the ascending colon were found. Only one of the patients
had profuse diarrhea, and two patients had no diarrhea prior to laparotomy.
Postoperatively, Clostridium difficile colitis was diagnosed by stool toxin
assay and was confirmed in one case by proctosigmoidoscopic biopsy results.
Antibiotic-associated colitis must be considered in any patient who
develops peritoneal signs while or after receiving antibiotics. Over a
two-year period, the "acute abdomen" presentation accounted for 5.2% of all
patients with C difficile colitis at our institutions. Early
proctosigmoidoscopy or stool examination for C difficile or its toxin may
avoid unnecessary laparotomy in such patients.
