PSEUDOMEMBRANOUS ENTEROCOLITIS

General Information

DEFINITION--A rare, severe illness in the small and large intestines. It usually follows 5 to 7 days after extensive gastrointestinal surgery and antibiotic treatment in a person who was debilitated before surgery. It is characterized by inflammation and tissue death of the lining membrane and deeper layers of the intestine.

BODY PARTS INVOLVED--Large and small intestines.

SEX OR AGE MOST AFFECTED--Adults, especially those over age 60.

SIGNS & SYMPTOMS

• Watery diarrhea (sometimes bloody) with abdominal cramps.
• Fever; nausea and vomiting.
• Drop in blood pressure, sometimes to shock levels, with weak pulse and rapid heartbeat.
• Disorientation.
• Symptoms may begin during the antibiotic treatment or may appear 1-10 days after the treatment has stopped.

CAUSES--Infection from bacteria, usually Clostridium difficile, which manufactures a toxin that causes the symptoms; or from the staphylococcus germ. These germs normally inhabit the intestinal tract. They cause enterocolitis when other normal bacterial of the intestinal tract have been killed by heavy use of broad-spectrum antibiotics. This upsets the bacterial balance of the intestinal tract. The illness usually occurs as a complication of surgery.

RISK INCREASES WITH

• Adults over 60.
• Recent surgery with a drop in blood pressure during surgery.
• Kidney failure.
• Obesity; poor nutrition.
• Use of antibiotics, especially lincomycin, clindamycin, ampicillin, chloramphenicol, cephalosporins, penicillin or sulfa drugs.

HOW TO PREVENT--No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory culture of the stool, biopsy (See Glossary) of the membrane lining of the large intestine through a colonoscope (See Glossary). Note: A barium enema should not be administered. It may cause intestinal perforation.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• The most important aspect of treatment is to discontinue use of the antibiotic causing the illness.
• Hospitalization for intravenous nutrition and intensive care in moderate to severe cases.

POSSIBLE COMPLICATIONS--

The following occur only if the problem is not recognized and treated:

• Shock and severe dehydration.
• Peritonitis caused by perforation of the intestine.

PROBABLE OUTCOME--Symptoms will usually disappear in 1 to 2 weeks after the offending antibiotic is discontinued. A substitute antibiotic is usually not prescribed; the body's defense mechanisms must take over for the withdrawn antibiotic. The worst cases are fatal.

How To Treat

GENERAL MEASURES----While in the hospital, you will be monitored closely for any changes in your vital signs, electrolyte imbalances, your fluid intake and output (including fluid lost in stools), signs of possible shock and your level of consciousness.

MEDICATION--

• Your doctor may prescribe: Cholestyramine, vancomycin or metronidazole to prevent secondary, nonbacterial infections that occur when the balance of intestinal organisms is upset. High doses of cortisone for a short time to decrease inflammation.
• Don't take antidiarrheal drugs unless prescribed by your doctor. They may contribute to intestinal perforation.

ACTIVITY--Rest in bed until all symptoms of the illness disappear. Flex legs often while in bed to decrease the likelihood of deep-vein blood clots. Resume normal activities gradually.

DIET--Intravenous nourishment will be necessary at first, progressing to a liquid diet, a soft diet and finally to a normal diet.

Call Your Doctor If

• You have symptoms of pseudomembranous enterocolitis following intestinal surgery.
• Symptoms return after treatment.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.