Zusammenfassung
GRUNDLAGEN: Eine nosokomiale Clostridium difficile-assoziierte Kolitis tritt in 1–4 % aller chirurgischen Patienten auf. In 3–5 % kann hieraus ein toxisches Megakolon mit schwerer Sepsis entstehen, welches dann einer chirurgischen Intervention bedarf. METHODIK: Fallbericht. ERGEBNISSE: Bei einer Patientin mit ausgeprägter Neutropenie nach Stammzelltransplantation, die wegen einer akuten lymphatischen Leukämie durchgeführt wurde, entwickelte sich trotz adäquater Therapie mit Metronidazol und Vancomycin ein toxisches Megakolon. Nach erfolgloser medikamentöser Therapie wird zunächst eine Hemikolektomie rechts, dann eine subtotale Kolektomie durchgeführt. Dadurch wird zwar das TM erfolgreich therapiert, jedoch gelingt es der anhaltend neutropenischen Patientin trotzdem nicht sich suffizient zu erholen, sodass sie in ein Multiorganversagen verfällt, in dem sie letztendlich verstirbt. SCHLUSSFOLGERUNGEN: Patienten mit zu erwartender länger anhaltender Neutropenie, die ein toxisches Megakolon entwickeln, sollten möglichst rasch mit einer subtotalen Kolektomie operativ behandelt werden, da die Infektion auch unter optimaler antibiotischer Therapie zu einem unkontrollierbarem Mulitorganversagen fortschreiten kann.
Summary
BACKGROUND: Nosocomial Clostridium difficile-associated colitis occurs in 1–4 % of surgical patients. In 3–5 %, it may progress to toxic megacolon (TM) and severe sepsis, requiring surgical intervention. METHODS: Case report. RESULTS: A patient suffering from neutropenia following peripheral blood stem-cell transplantation for acute lymphatic leucemia developed TM despite therapy with Metronidazol and oral Vancomycin. Ultimately she underwent right sided and subsequently subtotal colectomy. After successful treatment of TM the patient died later from multiorgan failure in the course of prolonged neutropenia. CONCLUSIONS: Patients with expected prolonged neutropenia who develop toxic megacolon should undergo subtotal colectomy without delay as they seem not to be able to control the infection even when receiving appropriate antibiotic therapy.
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Biebl, M., Stelzmüller, I., Nachbaur, D. et al. Fatal Clostridium difficile-associated toxic megacolon following unrelated stem-cell transplantation. Eur Surg 38, 217–221 (2006). https://doi.org/10.1007/s10353-006-0224-1
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DOI: https://doi.org/10.1007/s10353-006-0224-1