A case of severe pseudomembranous colitis with septic shock

偽膜性大腸炎は抗菌薬関連消化管病変の一つで,CD(Clostridium difficile)が起因菌となる事が多い.急速に増悪し敗血症性ショックを呈した1例を経験したので報告する.症例は79歳女性.他院で尿路感染症に対し抗菌薬治療を受けていた所,嘔吐を来し,ショック状態となり当科に紹介された.初診時意識不明瞭でSIRS,DIC状態であった.腹部CT検査で左半結腸に全周性の壁肥厚を認め,便中のCD toxin陰性であったが治療歴から偽膜性大腸炎による腹膜炎を強く疑い,同日緊急手術施行.左半結腸は壁肥厚･島状菲薄および黒色壊死像を認めたため切除し横行結腸に人工肛門を造設した.切除標本の培養検査でCD陽性,病理組織検査で偽膜性大腸炎と診断された.偽膜性大腸炎の重症例で急性腹症例,ショック例などでは手術を考慮すべきとされている.自験例も時期を逸することなく積極的な手術療法を行い良好な経過を得た.

Pseudomembranous colitis is one of the antibiotics associated gastrointestinal diseases. The important causal bacterium is clostridium difficile(CD).We herein report a case of pseudomembranous colitis with septic shock. 79 years old woman who was taking antibiotics by urinary tract infection in previous hospital. She was admitted to our hospital because of abdominal bloating, vomiting and shock. She met the criteria for SIRS and DIC. CT indicated ascites and highly wall thickness from descending colon to rectum. Feces CD toxin was negative. We performed left colectomy and transverse colostomy because of suspicion of pseudomembranous colitis. The resected specimen showed pseudomembrane formation and extensive edema and partial thinness in the colon. Histological examinations revealed pseudomembranous colitis. Severe pseudomembranous colitis suffered from peritonitis, sepsis and shock has a poor prognosis. Severe pseudomembranous colitis patients could require surgical intervention at the appropriate time to improve survival.

偽膜性大腸炎

Clostridium difficile感染

敗血症