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Chouillard et al. Mini-invasive Surg 2021;5:9 I http://dx.doi.org/10.20517/2574-1225.2020.108 Page 3 of 6

A B

Figure 1. Pelvic magnetic resonance imaging (MRI) scan in a 47-year old woman with pain and febrile diarrhea 2 weeks after total
mesorectal excision (TME) with colo-anal anastomosis: (A) small arrows in a circle at the bottom of the image show fluid next to the
colo-anal anastomosis evoking leak. Large arrow on the right of the image shows massive intra-peritoneal fluid. Note the concern for
colonic wall thickening (horizontal arrow); (B) small arrows show what was considered as extravasation of contrast in the vicinity of the
colo-anal anastomosis.

ileostomy closure after a normal pelvic CT scan with contrast. He received one dose of prophylactic
antibiotics (cefuroxime 1 g IV) at the induction of anesthesia. The immediate postoperative outcome was
uneventful. Ten days postoperatively, the patient started having diffuse abdominal pain and watery diarrhea
with 6 to 7 bowel movements per day. Physical examination revealed fever at 39 °C, tachycardia at 112
BPM, and hypertension at 170/100 mmHg. Abdominal examination, including digital rectal examination,
was normal. Blood chemistries were consistent with acute renal failure (blood urea nitrogen at 61 mg/dL;
3
creatinine at 2.9 mg/dL), leukocytosis with white blood count at 23,000/mm , and increased CRP at 252 mg/L.
Stool testing for toxin-producing CD was positive. Treatment was with 2 g of oral vancomycin for 10 days.
The patient’s renal function fully recovered without the need for dialysis. Neither patient received adjuvant
chemotherapy.

DISCUSSION
Symptoms of CD colitis such as pain, diarrhea, and increased CRP may be indistinguishable from other
causes of intra-abdominal sepsis (i.e., anastomotic leak, pelvic abscess, or iatrogenic bowel injury). This
[7]
could cause delay in the diagnosis of CDI, which could be fatal . In the literature, we could only find a
few papers that reported CDI after closure of ileostomy [7-11] . In some reported cases, as in our first case, the
presentation was confusing, and the diagnosis was delayed. In another case, the disease was even much
more severe (fulminant colitis), and the patient deteriorated quickly and died following an emergency total
colectomy .
[7]