The Roentgen Findings in Severe Pseudomembranous Enterocolitis

Pseudomembranous enterocolitis has been a major clinical problem, particularly so since the recognition of increasing numbers of bacteria which are resistant to broad-spectrum antibiotics (2–6, 8, 11, 12, 15, 17. 20, 21, 25). Surgical interest in the problem (7–10, 16, 19, 21, 22, 24, 25) has led to much recent study, but the condition was reported in the nineteenth century (25). In spite of numerous articles on the subject, radiographic findings are mentioned in passing in only two (17, 18), and then in a negative sense. The purpose of this study is to describe the roentgen findings as illustrated by a survey of proved cases of pseudomembranous enterocolitis. Clinical Observations The age range of the disease is from birth through the geriatric group (7, 16). Initial manifestations may be nonspecific. Abdominal distention, usually without borborygmi, is a frequent finding. Nausea and vomiting may appear in the first four days. On the third or fourth day, diarrhea occurs in as many as half the cases. Ileus is the most common finding. Sudden onset with outpouring of fluid into the intestinal tract, with marked dehydration, collapse, oliguria, renal shutdown, electrolyte imbalance, and adrenal exhaustion, with ultimate collapse (7, 8, 13, 17, 24, 25) ensue. As many as 91 per cent of the patients in one series died (22). Etiology Multiple factors have been incriminated in the causation of pseudomembranous enterocolitis. Inorganic and metabolic poisons have been mentioned (9, 17). Mechanical and adynamic ileus are extremely important, the former being one of the leading factors (17). It is usually related to carcinoma of the colon (13, 19). The number of cases has certainly increased with the wide use of antibiotics (1, 5, 6, 8, 19, 20, 24), particularly in conjunction with surgery. The intestinal bacterial flora are altered and, as a result, an over-growth of resistant bacteria such as Micrococcus pyogenes and Proteus vulgaris occurs. Vascular occlusive changes with infarction have been mentioned as a possible cause (7). Carcinoma of the intestine and other wasting diseases with vitamin deficiencies are common in patients with pseudomembranous enterocolitis. Long-term treatment with antibiotics acts to eliminate Escherichia coli, a pantothenic acid synthesizer, thereby leading to the multiplication of such organisms as those mentioned above, which require pantothenic acid. Thus pseudomembranous enterocolitis may be a manifestation of nutritional deficiencies associated with debility (11). Pathology The entire intestinal tract (8, 23) can be involved, but the small intestine is the most frequent site. Combined upper respiratory tract and gastrointestinal tract lesions which were histologically similar have been reported in a case of staphylococcal toxemia (23). Two changes are described, either alone or together.