The Experts below are selected from a list of 2421 Experts worldwide ranked by ideXlab platform
Erik C Von Rosenvinge - One of the best experts on this subject based on the ideXlab platform.
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Pseudomembranous Colitis not always clostridium difficile
Cleveland Clinic Journal of Medicine, 2016Co-Authors: Derek M Tang, Nathalie H Urrunaga, Erik C Von RosenvingeAbstract:Although Clostridium difficile infection is the cause of most cases of Pseudomembranous Colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause.
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Pseudomembranous Colitis not always caused by clostridium difficile
Case Reports in Medicine, 2014Co-Authors: Derek M Tang, Nathalie H Urrunaga, Hannah De Groot, Erik C Von Rosenvinge, Guofeng Xie, Leyla GhaziAbstract:Although classically Pseudomembranous Colitis is caused by Clostridium difficile, it can result from several etiologies. Certain medications, chemical injury, collagenous Colitis, inflammatory bowel disease, ischemia, and other infectious pathogens can reportedly cause mucosal injury and subsequent pseudomembrane formation. We present the case of a middle-aged woman with vascular disease who was incorrectly diagnosed with refractory C. difficile infection due to the presence of pseudomembranes. Further imaging, endoscopy, and careful histopathology review revealed chronic ischemia as the cause of her Pseudomembranous Colitis and diarrhea. This case highlights the need for gastroenterologists to consider non-C. difficile etiologies when diagnosing Pseudomembranous Colitis.
George Triadafilopoulos - One of the best experts on this subject based on the ideXlab platform.
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decompressive colonoscopy with intracolonic vancomycin administration for the treatment of severe Pseudomembranous Colitis
Surgical Endoscopy and Other Interventional Techniques, 2001Co-Authors: Katerina Shetler, R Nieuwenhuis, Sherry M Wren, George TriadafilopoulosAbstract:Background: We explored the potential of early decompressive colonoscopy with intracolonic vancomycin administration as an adjunctive therapy for severe Pseudomembranous Clostridium difficile Colitis with ileus and toxic megacolon. Methods: We reviewed the symptoms, signs, laboratory tests, radiographic findings, and outcomes from the medical records of seven patients who experienced eight episodes of severe Pseudomembranous Colitis with ileus and toxic megacolon. All seven patients underwent decompressive colonoscopy with intracolonic perfusion of vancomycin. Results: Fever, abdominal pain, diarrhea, abdominal distention, and tenderness were present in all patients. Five of seven patients were comatose, obtunded, or confused, and six of the seven required ventilatory support. The white blood cell count was greater than 16,000 in seven cases (six patients). Colonoscopy showed left-side Pseudomembranous Colitis in one patient, right-side Colitis in one patient, and diffuse Pseudomembranous panColitis in five patients. Two patients were discharged with improvement. Five patients had numerous medical problems leading to their death. Complete resolution of Pseudomembranous Colitis occurred in four patients. One patient had a partial response, and two patients failed therapy. Conclusion: Colonoscopic decompression and intracolonic vancomycin administration in the management of severe, acute, Pseudomembranous Colitis associated with ileus and toxic megacolon is feasible, safe, and effective in approximately 57% to 71% of cases.
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acute abdomen as the first presentation of Pseudomembranous Colitis
Gastroenterology, 1991Co-Authors: George Triadafilopoulos, Ann E HallstoneAbstract:Abstract Acute abdomen was the presenting manifestation of Pseudomembranous Colitis in six men who had previously been treated with antibiotics and presented with abdominal distention, pain, fever, and leukocytosis with absent or mild diarrhea. Plain abdominal radiographs revealed megacolon in two, combined small and large bowel dilation in three, with one of them showing volvuluslike pattern, and isolated small bowel ileus in one. Emergency colonoscopy was performed successfully in all patients and revealed pseudomembranes in five and nonspecific Colitis in one. All patients had positive latex test results for Clostridium difficile , and two tested positive for cytotoxicity. All patients were treated with IV metronidazole, resulting in resolution of symptoms and abdominal findings. In addition, two patients underwent colonoscopic decompression with improvement. Endoscopically, complete resolution of the pseudomembranes occurred at 4 weeks in all cases. No patient had a recurrence. It is concluded that (a) Pseudomembranous Colitis may present as abdominal distention mimicking small bowel ileus, Ogilvie's syndrome, volvulus, or ischemia; (b) in such cases, emergency colonoscopy is safe and useful for diagnosis and therapeutic decompression and may obviate the need for surgery; and (c) treatment with IV metronidazole is effective. Colitis due to C. difficile should be considered in the differential diagnosis of acute abdomen in patients previously treated with antibiotics.
Christopher R Mantyh - One of the best experts on this subject based on the ideXlab platform.
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increased substance p receptor expression by blood vessels and lymphoid aggregates in clostridium difficile induced Pseudomembranous Colitis
Digestive Diseases and Sciences, 1996Co-Authors: Christopher R Mantyh, John E Maggio, Patrick W Mantyh, Steven R VignaAbstract:Pseudomembranous Colitis is most often caused by toxins secreted by Clostridium difficile following bowel flora overgrowth after antibiotic use. The secretory and inflammatory effects observed in C. difficile toxin A-induced enteroColitis in the rat ileum are inhibited by CP-96,345, a substance P (SP) receptor antagonist. To determine if SP plays a role in the pathogenesis of human Pseudomembranous Colitis, SP receptor distribution was examined in a toxin A-positive specimen of bowel. Quantitative receptor autoradiography was used to examine SP receptors in tissue from a patient who tested positive for C. Difficile toxin. SP receptors were massively increased in small blood vessels and lymphoid aggregates in the Pseudomembranous Colitis bowel in comparison to control specimens. The SP binding was saturable and exhibited similar affinities for SP and CP-96,345. SP may contribute to the inflammatory response in Pseudomembranous Colitis via a massive increase in SP receptor antagonists may offer a novel therapeutic intervention for Pseudomembranous Colitis.
Elliot K Fishman - One of the best experts on this subject based on the ideXlab platform.
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Pseudomembranous Colitis spectrum of imaging findings with clinical and pathologic correlation
Radiographics, 1999Co-Authors: Satomi Kawamoto, Karen M Horton, Elliot K FishmanAbstract:Pseudomembranous Colitis (PMC) is a potentially life-threatening acute infectious Colitis caused by one or more toxins produced by an unopposed proliferation of Clostridium difficile bacteria. PMC is characterized by the presence of elevated, yellow-white plaques forming pseudomembranes on the colonic mucosa. These plaques can be visualized at both pathologic analysis and endoscopy. Plain radiography, contrast enema studies, and computed tomography (CT) are useful in the evaluation of PMC. Plain radiography of the abdomen can demonstrate polypoid mucosal thickening, "thumbprinting" (wide transverse bands associated with haustral fold thickening), or gaseous distention of the colon. A toxic megacolon with distention and occasionally pneumoperitoneum may be seen in the most severe cases of PMC involving perforation. At contrast enema studies, the primary finding in mild cases of PMC is small nodular filling defects representing the mucosal plaques. With more extensive colonic involvement, the plaques are larger and coalesce to form an irregular bowel wall margin. Mural thickening and wide haustral folds caused by intramural edema may also be seen. A contrast enema study is contraindicated in patients with severe PMC due to the danger of perforation. Common CT findings include wall thickening, low-attenuation mural thickening corresponding to mucosal and submucosal edema, the "accordion sign," the "target sign" ("double halo sign"), pericolonic stranding, and ascites. Familiarity with these imaging characteristics may allow early diagnosis and treatment and prevent progression to more serious pathologic conditions.
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Pseudomembranous Colitis can ct predict which patients will need surgical intervention
Journal of Computer Assisted Tomography, 1999Co-Authors: Satomi Kawamoto, Karen M Horton, Elliot K FishmanAbstract:Purpose: Our purpose was to determine if patients with Pseudomembranous Colitis (PMC) requiring surgical intervention demonstrate radiographic features distinct from those of patients treated successfully with standard medical therapy. Method: The indications for a CT study and the imaging findings from 17 patients who required laparotomy with colon resection for PMC were retrospectively reviewed. The CT findings were compared with the findings from 17 control patients (matched by clinical presentation) with PMC who were treated medically and did not require surgical intervention. Results: None of the CT findings evaluated in this study were significantly different between the surgical and nonsurgical groups. The CT findings evaluated for the surgical and nonsurgical groups, respectively, were as follows: wall thickness of the colon: 17.8 ± 6.6 and 16.9 ± 3.9 mm; largest caliber of the colon: 6.8 ± 1.6 and 6.1 ± 1.2 cm; presence of the accordion sign: 52.9 and 70.6%; heterogeneous contrast enhancement pattern (target sign): 57.1 and 57.1%; pericolonic stranding: 82.4 and 88.2%; ascites: 70.6 and 58.8%; pleural effusion(s): 64.7 and 64.7%; and subcutaneous edema: 64.7 and 64.7%. Conclusion: Although none of the CT findings evaluated in this study was significantly different between the surgical and nonsurgical groups, CT was often the initial diagnostic modality in both groups. It is important for radiologists to recognize the CT appearance of PMC and suggest the diagnosis. However, patient triage may not be based solely on the CT findings.
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Pseudomembranous Colitis ct evaluation of 26 cases
Radiology, 1991Co-Authors: Elliot K Fishman, Madhav Kavuru, Bronwyn Jones, Janet E Kuhlman, Dimitri Merine, Keith D Lillimoe, Stanley S SiegelmanAbstract:Pseudomembranous Colitis (PMC) is an infectious Colitis usually occurring as a complication of antibiotic use. The computed tomographic (CT) appearances of 26 patients with PMC were reviewed. Twenty-three patients demonstrated an abnormal bowel wall, with an average wall thickness of 14.7 mm (range, 3-32 mm); in three patients, bowel wall thickness was normal. Contrast material trapped between thickened folds corresponded to the broad transverse bands described on plain radiographs. Pancolonic involvement was seen in 13 cases, while seven patients had right-sided involvement only; three patients had bowel wall thickening limited to the rectosigmoid only. Although the CT appearance of PMC is not highly specific, the diagnosis may be suggested in the proper clinical setting.
Derek M Tang - One of the best experts on this subject based on the ideXlab platform.
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Pseudomembranous Colitis not always clostridium difficile
Cleveland Clinic Journal of Medicine, 2016Co-Authors: Derek M Tang, Nathalie H Urrunaga, Erik C Von RosenvingeAbstract:Although Clostridium difficile infection is the cause of most cases of Pseudomembranous Colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause.
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Pseudomembranous Colitis not always caused by clostridium difficile
Case Reports in Medicine, 2014Co-Authors: Derek M Tang, Nathalie H Urrunaga, Hannah De Groot, Erik C Von Rosenvinge, Guofeng Xie, Leyla GhaziAbstract:Although classically Pseudomembranous Colitis is caused by Clostridium difficile, it can result from several etiologies. Certain medications, chemical injury, collagenous Colitis, inflammatory bowel disease, ischemia, and other infectious pathogens can reportedly cause mucosal injury and subsequent pseudomembrane formation. We present the case of a middle-aged woman with vascular disease who was incorrectly diagnosed with refractory C. difficile infection due to the presence of pseudomembranes. Further imaging, endoscopy, and careful histopathology review revealed chronic ischemia as the cause of her Pseudomembranous Colitis and diarrhea. This case highlights the need for gastroenterologists to consider non-C. difficile etiologies when diagnosing Pseudomembranous Colitis.
