CLOSTRIDIUM DIFFICILE COLITIS CAUSING ABDOMINAL COMPARTMENTAL SYNDROME

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CLOSTRIDIUM DIFFICILE COLITIS CAUSING ABDOMINAL
COMPARTMENTAL SYNDROME

• Nissar Shaikh1, Marie-Anne Kettern1, Yolande
  Hanssens2, Sittana Elshafie3, André Louon1
• Hamad Medical Corporation Departments of
  Anesthesia and Intensive Care1, Pharmacy2
  Microbiology3
• Doha State of Qatar

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Introduction

• Clostridium difficile is a gram positive
  anaerobic spore forming bacillus
• Common nosocomial infection
• Antibiotic associated diarrhea and colitis
• ? 2nd and 3rd generation cefalosporins,
  ampicillin, and clindamycin.
• Manifestations range from asymptomatic carrier
  state to fulminant colitis

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Case report - summary

• 36 yr old male, post road traffic accident,
  developed diarrhoea after 5 days of ceftriaxone
  (2 gram q24H)
• ? Clostridium difficile colitis
• Complicated by abdominal distension, paralytic
  ileus, intra abdominal hypertension, renal
  failure
• Abdominal compartment syndrome.
• Pseudomembrane colitis, confirmed on colonoscopy

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Discussion

• Presence of high intra abdominal pressure with
  deterioration of renal function.
• Other causes of ARF in ICU excluded.
• Patient responded to discontinuation of
  antibiotic and treatment with metronidazole,
  properistaltic drug and frusemide.
• The improvement in renal function paralleled the
  decrease in intraabdominal pressure.

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Conclusion

• Renal failure was due to abdominal compartment
  syndrome.
• Neurological deterioration was due to intra
  abdominal hypertension and its effect on the
  central nervous system.
• To our knowledge - first case reported as
  clostridium difficile colitis leading to
  abdominal compartment syndrome.

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Thank you