Loop ileostomyで救命したfulminant Clostridioides difficile colitisの1例(A case of fulminant Clostridioides difficile colitis treated with loop ileostomy)

• Published in: Nihon Kyūkyū Igakkai zasshi 2021-04, Vol.32 (4), p.202-207
• Main Authors: (Hiroaki Suzuki), 鈴木 大聡, (Jun Hamaguchi), 濱口 純, (Takeo Matsuyoshi), 松吉 健夫, (Hitoshi Kaneko), 金子 仁, (Daiyuu Kosen), 光銭 大裕, (Keiki Shimizu), 清水 敬樹, (Yasufumi Miyake), 三宅 康史
• Format: Article
• Language: English
• Subjects: ileostomy; subtotal colectomy; vancomycin; バンコマイシン; 人工肛門; 大腸亜全摘
• ISSN: 1883-3772; 1883-3772
• DOI: 10.1002/jja2.12580

要旨 　症例は75歳の女性。Clostridioides difficile infection再発による下痢と血圧低下のために当センターに紹介となった。Fulminant Clostridioides difficile colitisと診断しバンコマイシンの内服とメトロニダゾールの静脈投与を開始したが奏効しなかったため，第2病日にloop ileostomyを造設し大腸内の減圧とバンコマイシンの注腸を開始した。その後徐々に循環動態が改善し，第19病日にカテコラミンを中止することができた。本症例は重篤な状態であったが，loop ileostomyという比較的侵襲の少ない外科治療を選択したことで救命につながったと考えられた。 ABSTRACT A 75–year–old female patient with a history of diarrhea and low blood pressure caused by recurrent Clostridioides difficile infections was admitted to our hospital. Fulminant Clostridioides difficile colitis was diagnosed, and oral vancomycin and intravenous metronidazole administration was begun, but she failed to respond to the treatment. A loop ileostomy was performed, and intestinal infusion of vancomycin was begun on the following day. Thereafter her condition gradually improved, and vasopressor administration was able to be stopped on admission day 19. Despite the severity of her condition, the patient survived thanks to the loop ileostomy, a minimally invasive treatment, which was thought to be key to the successful treatment of patient.