van Genderen Michel E, Jonkman Jeroen G J, van Rijn Michiel, Dees Adriaan
Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands.
Department of Radiology, Ikazia Hospital, Rotterdam, The Netherlands.
BMJ Case Rep. 2014 Dec 17;2014:bcr2014207265. doi: 10.1136/bcr-2014-207265.
A 78-year-old woman with long-standing obstipation presented herself to the hospital with diarrhoea and progressive abdominal cramping since 2 days. Acute abdomen developed and an emergency exploratory laparotomy was indicated, which showed no signs of bowel ischaemia. After admission to the internal ward, stool Clostridium difficile PCR was tested positive. Hence the diagnosis of pseudomembranous colitis became apparent. Abdominal imaging demonstrated multiple gas foci in the wall of the bladder and extensive pseudomembranous colitis. The patient was initially treated with oral vancomycin and secondarily with metronidazole for recurrent C. difficile infection. Resolution of diarrhoea and abdominal cramping was noted on 6-week follow-up visit.
一名患有长期便秘的78岁女性因腹泻和进行性腹部绞痛2天前来医院就诊。出现急腹症，遂行急诊剖腹探查术，术中未发现肠缺血迹象。入住内科病房后，粪便艰难梭菌聚合酶链反应检测呈阳性。因此，伪膜性结肠炎的诊断明确。腹部影像学检查显示膀胱壁有多个气体灶以及广泛的伪膜性结肠炎。患者最初接受口服万古霉素治疗，后来因艰难梭菌反复感染改用甲硝唑治疗。在6周的随访中，腹泻和腹部绞痛症状消失。
