Abstract
A 59-year-old man diagnosed with rectal carcinoma (Rb, cT2N0M0, Stage I) underwent laparoscopic resection of the internal anal sphincter (with transanal total mesorectal excision) and prophylactic double-orifice ileostomy. His postoperative course was good, and he was discharged on Day 9. On Day 17, he was diagnosed with intestinal obstruction due to narrowing of the colostomy exit and re-admitted. The drainage fluid was positive for Clostridium difficile (CD) toxin, and CD enteritis was diagnosed. Conservative therapy was started, but on Day 4 after admission, the patient's general condition suddenly deteriorated. Septic shock was diagnosed, and he was admitted to the intensive care unit (ICU). Computed tomography (CT) showed marked thickening of the ileum with edema. Fulminant CD enteritis was diagnosed, and emergency small-bowel resection was performed. Postoperatively, the patient's condition improved with vancomycin administration via enema and multimodal treatments, and he was discharged home on Day 22 after the second operation. Fulminant CD enteritis occurs rarely in the small intestine, and the case of a patient whose life was saved by intensive care is reported.
