pseudomembranous colitis endoscopy prognosis

pseudomembranous colitis endoscopy prognosis

An acute illness with often severe diarrhoea that follows therapy with ampicillin, clindamycin, metronidazole, and other broad-spectrum antibiotics which eliminate the patient’s native bacterial flora, resulting in superinfection by Clostridium difficile (which causes most cases). It may occur in compromised hosts or the elderly, in a background of colonic obstruction, leukaemia, major surgery, uraemia, spinal injury, colorectal cancer, burns, infections, shock, heavy-metal poisoning, haemolytic-uremic syndrome, ischaemia, Crohn’s disease, shigellosis, necrotising enterocolitis, or Hirschsprung’s disease.
 
Clinical findings
Ranges from asymptomatic, to mild diarrhoea and abdominal pain, to fulminant colitis with fever, increased white cells, vomiting, dehydration, perforation, peritonitis, shock.

Complications
Dehydration, electrolyte imbalance, colonic perforation, toxic megacolon.

DiffDx
Ischaemic colitis with pseudomembtanes, fibrosis of the lamina propria with hyalinisation due to ischaemia, mucosal haemorrhage, full-thickness mucosal necrosis, microthrombi.

Endoscopy
Inflammation, friable yellow membranes on surface.

Management
Fluid and electrolyte support; discontinue antibiotics, treat with vancomycin.

Prognosis
Up to 20% of cases recur.

Pseudomembranous colitis lesion types
Type 1: Epithelial cell necrosis and acute inflammation of intercryptal interface; no damage to crypt neck or deep crypt.

Type 2: 50% of cases; classic eruptive (”volcano”) exudate; damage to crypt neck and deeper crypts.

Type 3: Full-thickness mucosal necrosis.