Waddell T K, McLeod R S, Rotstein O D, Cohen Z
Division of General Surgery, Toronto General Division of The Toronto Hospital, Ont.
Can J Surg. 1992 Oct;35(5):555-9.
The presentation of pseudomembranous colitis ranges from mild self-limiting diarrhea to fulminant colitis with overwhelming sepsis. The management of the severe forms of this disease, including the role of surgical intervention, is poorly defined. To evaluate the management and outcome in severe cases, the authors reviewed the records of six patients (four women, two men) seen at The Toronto Hospital between 1985 and 1989 with pseudomembranous colitis manifesting as fulminant colitis. The patients ranged in age from 19 to 69 years (mean 52 years). All presented with nonbloody diarrhea, had peritoneal signs and were severely dehydrated, and all had received antibiotics between 4 days and 6 weeks before the onset of symptoms. The mean preoperative leukocyte count was 40.9 x 10(9)/L. Radiologically, the colon appeared to be dilated in three patients. Two patients were operated on immediately. The other four were treated medically, but three of them required surgery within 24 hours of presentation. Four (67%) of the six patients died. All four had been treated surgically. The mean age of the survivors was 28 years compared with 64 years for those who died. Pseudomembranous colitis can present as severe acute colitis and can carry a high mortality, especially in the aged. Surgical treatment may be required in those who fail to respond to medical management or have peritoneal signs.
伪膜性结肠炎的表现从轻度自限性腹泻到伴有严重败血症的暴发性结肠炎不等。这种疾病严重形式的治疗，包括手术干预的作用，目前定义尚不明确。为了评估重症病例的治疗及预后情况，作者回顾了1985年至1989年间在多伦多医院就诊的6例伪膜性结肠炎患者（4名女性，2名男性）的病历，这些患者均表现为暴发性结肠炎。患者年龄在19岁至69岁之间（平均52岁）。所有患者均表现为非血性腹泻，有腹膜刺激征且严重脱水，并且所有患者在症状出现前4天至6周内均接受过抗生素治疗。术前白细胞计数平均为40.9×10⁹/L。放射学检查显示，3例患者结肠扩张。2例患者立即接受了手术。另外4例接受了内科治疗，但其中3例在就诊后24小时内需要手术。6例患者中有4例（67%）死亡。死亡的4例患者均接受了手术治疗。幸存者的平均年龄为28岁，而死亡者为64岁。伪膜性结肠炎可表现为严重的急性结肠炎，且死亡率较高，尤其是在老年人中。对于内科治疗无效或有腹膜刺激征的患者可能需要进行手术治疗。
