Fulminant Clostridioides difficile colitis treated with diverting loop ileostomy and colonic lavage: a case report (secondary publication)

A 78-year-old man developed lower abdominal pain during antibiotic treatment for pneumonia and was admitted to the intensive care unit because of hemodynamic instability. Contrast-enhanced computed tomography revealed edematous changes extending from the ascending colon to the rectum, ascites, and increased density of the surrounding mesenteric fat. Blood tests showed a severe inflammatory response, acute renal failure, and metabolic acidosis, and the patient required continuous vasopressor administration for hemodynamic instability. Clostridioides difficile (CD) antigen and toxin were also detected, leading to a diagnosis of fulminant CD enterocolitis. Because colonic necrosis was suspected, exploratory laparotomy was performed. Operative findings showed no ischemic changes or wall thinning. The colon was preserved, and diverting loop ileostomy with colonic lavage was performed. Although total colectomy is the standard surgical treatment for fulminant CD enterocolitis, this case was successfully managed with ileostomy and colonic lavage.