SSAT - <i>CLOSTRIDIUM DIFFICILE</i> INFECTION: NO LONGER THE INFECTION OF ANTIBIOTIC ASSOCIATED DIARRHEA

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CLOSTRIDIUM DIFFICILE INFECTION: NO LONGER THE INFECTION OF ANTIBIOTIC ASSOCIATED DIARRHEA
Yizhi Shan^*, Prabhu Senthil-Kumar, Mark Zebley, Fernando Bonanni, Michael Nussbaum, Thai Vu, James Yuschak, Orlando Kirton, Ryan Shadis
Surgery, Abington Hospital, Abington, PA

Clostridium difficile infection is traditionally taught to be an antibiotic associated diarrhea. This diagnosis is based on the presence of clinical symptoms (usually defined as more than 3 watery, loose or unformed stool within 24 hours) coupled with a diagnostic test. There is now a new presentation of C. difficile infection, including progression to toxic megacolon, in patients without diarrhea.
We report a case series of 9 patients in a single institution who developed C. difficile infection without preceding diarrhea, and 4 patients needed a total colectomy.
All 9 patients had colitis with positive laboratory testing for C difficile toxin. They, however, presented with a lack of or minimal bowel movements. 6 patients had rapid development of abdominal distention. 7 patients received stool softeners, suppositories and/or enemas for presumed constipation. 4 patients had a mild course of infection and were successfully treated medically. The other 5 patients progressed rapidly to multisystem organ failure, and eventually required total colectomy. Out of the 5 patients that required total colectomy, 2 expired.
For patients who rapidly develop abdominal distention, especially if coupled with multi-system organ failure, C difficile infection must be part of the differential regardless of the presence of diarrhea.

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