Riverside University Health System Moreno Valley, CA
Award: Presidential Poster Award
Mena Saad, DO1, Jody Marie. Esguerra, MD2, Komail Mujtaba Ali, MBBS2, Manish Shrestha, MD1 1Riverside University Health System, Moreno Valley, CA; 2Riverside University Health System, Riverside, CA
Introduction: Clostridioides difficile infection (CDI) is a well-recognized cause of antibiotic-associated diarrhea and colitis. While the typical clinical presentation involves gastrointestinal symptoms, CDI can occasionally manifest with atypical complications, including pneumatosis intestinalis (PI). Here, we present a case of C. difficile-associated pneumatosis intestinalis, underscoring the importance of recognizing and managing this potentially life-threatening complication.
Case Description/Methods: A 75-year-old male initially presented with abdominal pain and respiratory distress, leading to a diagnosis of septic shock and peritonitis. Radiological imaging revealed pneumatosis intestinalis, prompting exploratory laparotomy. Exploratory laparotomy showed no features of bowel ischemia. Subsequent flexible sigmoidoscopy revealed pseudomembranes consistent with C. difficile colitis, despite a previous negative C. difficile toxin testing. Subsequent stool testing confirmed the presence of C. difficile toxins A and B. The patient underwent conservative treatment with Fidaxomicin, showing gradual improvement in diarrhea, leading to discharge to a skilled nursing facility. At one-month follow-up, the patient reported complete resolution of symptoms, with negative repeat C. difficile stool toxin assay confirming eradication of the infection.
Discussion: Pneumatosis intestinalis, characterized by the presence of gas within the bowel wall, is a rare complication of CDI. Its occurrence should prompt thorough evaluation for underlying conditions, including ischemic colitis. In this case, the presence of pneumatosis intestinalis raised concern for bowel ischemia, necessitating invasive diagnostic measures such as exploratory laparotomy. The identification of pseudomembranes during sigmoidoscopy, despite previous negative C. difficile testing, highlights the importance of clinical suspicion and the limitations of diagnostic tests. Treatment with Fidaxomicin resulted in successful resolution of symptoms and eradication of C. difficile infection, as evidenced by negative repeat testing. This case underscores the need for vigilance in recognizing atypical presentations of CDI and the efficacy of targeted antibiotic therapy in achieving favorable outcomes.
Figure: Image A: Abdominal CT showing distal small bowel pneumatosis (arrows) with diffuse distention of the small bowel. Image B: Pseudomembranous colitis within the sigmoid colon. Image C: Pseudomembranous colitis within the rectum.
Disclosures:
Mena Saad indicated no relevant financial relationships.
Jody Esguerra indicated no relevant financial relationships.
Komail Mujtaba Ali indicated no relevant financial relationships.
Manish Shrestha indicated no relevant financial relationships.
Mena Saad, DO1, Jody Marie. Esguerra, MD2, Komail Mujtaba Ali, MBBS2, Manish Shrestha, MD1. P3767 - Pneumatosis Intestinalis: An Unusual Complication of Pseudomembranous <i>Clostridioides difficile</i> Colitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
