Clostridium Difficile Enteritis Causing Small Bowel Perforation in the Absence of Common Risk Factors

Background: Clostridium difficile causing clinical disease of the small bowel is reported rarely in the literature, but may be increasing in incidence as overall Clostridium difficile infection (CDI) rates increase across the country. Common risk factors that have been reported in the literature for C. difficile enteritis include inflammatory bowel disease (IBD), recent antibiotic use, and gastrointestinal surgery. We report a unique case of C. difficile enteritis involving the small bowel with necrosis and perforation in the absence of common risk factors. Case Presentation: A 57-year-old African American female with no prior surgical history presented with acute abdominal pain with diarrhea and was found to have CDI. On hospital day eight, the patient de-compensated suddenly. She was found to have a small bowel perforation in the proximal jejunum with pathology demonstrating CDI involving the small bowel. Conclusion: Clostridium difficile infection involving the small bowel is being reported increasingly and can lead to perforation, especially in immunocompromised patients. Whereas C. difficile enteritis has been described previously involving the small bowel, this case is unique because the patient did not have any of the strongest risk factors for CDI and presented with acute necrosis and perforation of the jejunum.