An acute inflammation and necrosis of the small and large intestines, pseudo-membranous enterocolitis usually affects the mucosa but may extend into submucosa and, rarely, other layers. Marked by severe diarrhea, this rare condition is generally fatal in 1 to 7 days from severe dehydration and from toxicity, peritonitis, or perforation.
Pseudomembranous enterocolitis is thought to be caused by a change in the flora of the colon and an overgrowth of a toxin-producing strain of Clostridium difficile.
Pseudomembranous enterocolitis has occurred postoperatively in debilitated patients who have undergone reabdominal surgery and in patients who have been treated with broad-spectrum antibiotics. Ampicillin, clindamycin, and cephalosporins are suspected as causative factors. Immunocompromised patients (such as individuals with cystic fibrosis, neurologic disease, liver and renal disease, diabetes mellitus, malnutrition, and hematologic disorders) are at increased risk for this disease. Whatever the cause, necrosed mucosa is replaced by a pseudomembrane filled with staphylococci, leukocytes, mucus, fibrin, and inflamma-tory cells.
Pseudomembranous enterocolitis begins suddenly with copious watery diarrhea, abdominal pain, and fever. Diarrhea, with or without blood, and abdominal pain may occur within 48 hours after administration of the drug. Signs and symptoms may begin with mild to moderate watery diarrhea with lower abdominal cramping. As the disease progresses, the patient may have profuse watery diarrhea with up to 30 stools per day and abdominal pain. Low-grade fever, along with abdominal tenderness and leukocytosis, occurs.
In a small number of presenting patients, colitis will develop with bradycardia, fever, abdominal pain, and distention. Serious complications may be associated with this disorder. They include conditions such as severe dehydration, electrolyte imbalance, hypo-tension, shock, and colonic perforation.
With this disorder, diagnosis is difficult because of the abrupt onset of enterocolitis and the emergency situation it creates; therefore, consideration of patient history is essential. A rectal biopsy through sigmoidoscopy confirms pseudomembranous enterocolitis. Stool cultures can identify C. difficile.
A patient who’s receiving broad-spectrum antibiotic therapy requires immediate discontinuation of the antibiotics. If possible, medications that slow peristalsis should be avoided. Effective treatment usually includes orally administered metronidazole (250 mg). Oral vancomycin is usually given for severe or resistant cases, but this drug is costly.
Supportive treatment must main-tain fluid and electrolyte balance and combat hypotension and shock with pressors, such as dopamine and levar-terenol.
❑ Monitor vital signs, skin color, and level of consciousness. Be alert for signs of shock.
❑ Record fluid intake and output, including fluid lost in stools. Watch for dehydration (poor skin turgor, sunken eyes, and decreased urine output).
❑ Check serum electrolyte levels daily, and watch for signs and symptoms of hypokalemia, especially malaise and a weak, rapid, irregular pulse.
CLINICAL TIP: Excessive diarrhea may cause excoriation and skin breakdown. To decrease excoriation and facilitate drainage measurement, insert a rectal tube or large indwelling catheter (inserted but not inflated) into the rectum and attach it to a drainage bag to gravity as ordered.
Review other book chapters online related to Enterocolitis:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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