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Chouillard et al. Mini-invasive Surg 2021;5:9 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.108

Case Report Open Access

Clostridium difficile infection secondary to
ileostomy closure

Elie Chouillard, Marc-Anthony Chouillard, Nader El Kary, Belinda De Simone, Andrew A. Gumbs

Département de Chirurgie Digestive, Centre Hospitalier Intercommunal, de POISSY/SAINT-GERMAIN-EN-LAYE, Poissy
78300, France.
Correspondence to: Prof. Elie Chouillard, Département de Chirurgie Digestive, Centre Hospitalier Intercommunal, de POISSY/
SAINT-GERMAIN-EN-LAYE, 10 rue du Champ Gaillard, Poissy 78300, France. E-mail: chouillard@yahoo.com
How to cite this article: Chouillard E, Chouillard MA, Kary NE, De Simone B, Gumbs AA. Clostridium difficile infection secondary
to ileostomy closure. Mini-invasive Surg 2021;5:9. http://dx.doi.org/10.20517/2574-1225.2020.108
Received: 24 Nov 2020 First Decision: 21 Dec 2020 Revised: 23 Dec 2020 Accepted: 12 Jan 2021 Published: 9 Mar 2021

Academic Editors: Giulio Belli, Biondi Alberto Copy Editor: Yue-Yue Zhang Production Editor: Jing Yu

Abstract
Protective ileostomy may be a risk factor for the development of Clostridium difficile (CD) infection (CDI). In
the postoperative period signs of CDI may be particularly difficult to differentiate from intra-abdominal sepsis.
Presented here are 2 cases that developed CDI after ileostomy reversal. Two patients who underwent low anterior
resections after neoadjuvant chemoradiation with protective ileostomy developed fever, leukocytosis and elevated
serum C-reactive protein (CRP) levels. The first patient also had negative CD stool toxins and his signs were so
severe that he underwent a negative diagnostic laparoscopy and re-creation of ileostomy. The second patient
who presented in a similar fashion was more fortunate in that her CD stool toxin was positive and she was treated
successfully with oral vancomycin. CDI after ileostomy reversal after low anterior resection can be difficult to
diagnose. In the first patient, the situation was so misleading that diagnostic laparoscopy was required. Outcome
was eventually favorable in both cases. CDI must be high on the list of differential diagnoses for febrile patients
with a leukocytosis and elevated CRP level even in the setting of negative CD stool toxins. Prophylactic intravenous
metronidazole and/or vancomycin enemas should be considered prior to colorectal surgery when a protective
ileostomy is likely.

Keywords: Clostridium difficile, stoma, cancer, rectal, laparoscopy, surgery, pseudomembranous colitis

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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