Colitis pseudomembranosa con neumoperitoneo. ¿Cirugía?

Abstract

Pseudomembranous colitis is a pathology caused by Clostridium difficile (C. difficile). Its incidence in hospitalized patients is increasing, constituting approximately 1% of hospitalized patients treated with antibiotics. C. difficile is a Gram positive, anaerobic bacillus with the ability to release toxins with inflammatory and cytotoxic effects. Almost all cases are preceded by the consumption of antibiotics and their risk persists despite stopping the antibiotic, especially during the first month. In addition, feco-oral transmission poses a great risk of in-hospital dispersion and in other areas of health care. Its severity is variable, from asymptomatic carrier, to mild diarrhea, to cases of toxic megacolon or fulminant colitis with multiorganic dysfunction. The treatment in general is medical, although in the presence of toxic megacolon, or refractory to conservative treatment, surgery has an important role in the treatment of it. Occasionally, despite imaging tests indicating severity, the decision to surgery may be precipitated, and add comorbidity to the patient, so there is no clear indication of this. We present the case of a patient with severe complicated pseudomembranous colitis that associated pneumoperitoneum, to explain its management, and although it had initial criteria of poor prognosis, which led to surgical treatment, it presented an optimal resolution with conservative treatment.