Ke F, Dong ZH, Bu F, Li CN, He QT, Liu ZC, Lu J, Yu K, Wang DG, Xu HN, Ye CT. Clostridium difficile infection following colon subtotal resection in a patient with gallstones: A case report and review of literature. World J Gastrointest Surg 2024; 16(9): 3048-3056 [PMID: 39351567 DOI: 10.4240/wjgs.v16.i9.3048]
Corresponding Author of This Article
Chang-Tao Ye, MS, Doctor, Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Dajie, Chaoyang District, Changchun 130061, Jilin Province, China. 1312868086@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2024; 16(9): 3048-3056 Published online Sep 27, 2024. doi: 10.4240/wjgs.v16.i9.3048
Clostridium difficile infection following colon subtotal resection in a patient with gallstones: A case report and review of literature
Feng Ke, Zhen-Hua Dong, Fan Bu, Cheng-Nan Li, Qi-Tong He, Zhi-Cheng Liu, Ji Lu, Kai Yu, Da-Guang Wang, He-Nan Xu, Chang-Tao Ye
Feng Ke, Department of General Surgery, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130000, Jilin Province, China
Zhen-Hua Dong, Qi-Tong He, Zhi-Cheng Liu, Da-Guang Wang, He-Nan Xu, Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Changchun 130061, Jilin Province, China
Fan Bu, Department of Plastic and Aesthetic Surgery, The First Hospital of Jilin University, Changchun 130061, Jilin Province, China
Cheng-Nan Li, Department of Encephalopathy Rehabilitation, Chaoyi Hospital, Yanbian Korean Autonomous Prefecture, Yanji 133000, Jilin Province, China
Ji Lu, Kai Yu, Chang-Tao Ye, Department of Urology, The First Hospital of Jilin University, Changchun 130061, Jilin Province, China
Author contributions: Ke F, Yu K and Dong ZH contributed to study design, literature search and manuscript writing; He QT and Wang DG contributed to study selection and data analysis; Lu J, Li CN and Liu ZC contributed to data collection; Xu HN, Wang DG and Ye CT contributed to article guidance; All authors revised the manuscript and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Informed consent statement: Informed consent was obtained from the patient(s) (or relative/guardian) for the publication of all images, clinical data and other data included in the main manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Tao Ye, MS, Doctor, Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Dajie, Chaoyang District, Changchun 130061, Jilin Province, China. 1312868086@qq.com
Received: March 28, 2024 Revised: July 2, 2024 Accepted: July 10, 2024 Published online: September 27, 2024 Processing time: 174 Days and 20.9 Hours
Abstract
BACKGROUND
Clostridium difficile (C. difficile) infection (CDI) is a rare clinical disease caused by changes in the intestinal microenvironment, which has a variety of causes and a poor prognosis, and for which there is no standardized clinical treatment.
CASE SUMMARY
A patient experienced recurrent difficulty in bowel movements over the past decade. Recently, symptoms worsened within the last ten days, leading to a clinic visit due to constipation. The patient was subsequently referred to our department. Preoperatively, the patient was diagnosed with obstructed colon accompanied by gallstones. Empirical antibiotics were administered both before and after surgery to prevent infection. On the fourth day post-surgery, symptoms of CDI emerged. Stool cultures confirmed the presence of C. difficile DNA. Treatment involved a combination of vancomycin and linezolid, resulting in the patient's successful recovery upon discharge. However, the patient failed to adhere to the prescribed medication after discharge and was discovered deceased during a follow-up two months later.
CONCLUSION
CDI is the leading cause of nosocomial post-operative care, with limited clinical cases and poor patient prognosis, and comprehensive clinical treatment guidelines are still lacking. This infection can be triggered by a variety of factors, including intestinal hypoxia, inappropriate antibiotic use, and bile acid circulation disorders. In patients with chronic bowel disease and related etiologies, prompt preoperative attention to possible CDI and preoperative bowel preparation is critical. Adequate and prolonged medication should be maintained in the treatment of CDI to prevent recurrence of the disease.
Core Tip: Clostridium difficile infection, a rare and serious condition, often lacks standardized treatment. A case involved obstructed colon and subsequent infection post-surgery, successfully treated with vancomycin and linezolid. However, non-adherence to medication led to patient fatality. Timely preoperative assessment and prolonged treatment are crucial for chronic bowel disease patients. More comprehensive clinical guidelines are needed.
