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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr0220102728.
Published online Oct 21, 2010. doi:  10.1136/bcr.02.2010.2728
PMCID: PMC3027549
Reminder of important clinical lesson
Clostridium difficile infection in the absence of a colon
Mohid S Khan,1 D Levy,2 and S Mann1
1Department of Gastroenterology, Gastroenterology, Neuroendocrine tumour unit, Royal Free Hospital, London, UK
2Department of Elderly Care Medicine, Barnet Hospital, Barnet, London, UK
Correspondence to Dr Mohid S Khan, mohidkhan/at/
Clostridium difficile (CD) infection is almost always confined to the colon causing a spectrum of illness ranging from diarrhoea to fulminant colitis. CD infection of the small intestine has been described but the identification of CD toxin in the stoma effluent of a patient with an end ileostomy is rare. We describe a 91-year-old woman, with a history of proctocolectomy for ulcerative colitis, presenting with profuse ileostomy diarrhoea after a course of antibiotics. Ileostomy effluent was positive for CD toxin but the patient died despite appropriate treatment. This suggests that the small intestine is susceptible to CD infection in antibiotic-treated patients many years after a colectomy. CD enteritis should be considered in all patients with increased ileostomy diarrhoea despite the absence of a colon.
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