Infective and ischaemic colitis

Key points

Clostridium difficile colitis

Gram +ve rod

Toxins A + B

Pseudomembranous colitis

Clindamycin use is a risk factor

IBD patients have high rates of C.Diff colonisation

Indications for surgery:

Critical condition - not responding to medical management (may or may not have toxic megacolon)

Perforation

Standard is subtotal colectomy (may need damage control)

Then antibiotics and Vancomycin enemas for 10 days post op

Loop ileostomy is alternative but minimal data - can do antegrade vancomycin flushes

Neutropenic colitis

AKA Typhlitis

Examples of causative agents:

• Steroids

• Etoposide

• Doxorubicin

• Methotrexate

• Vincristine

• Carboplatin

• Cyclophosphamide

7–10 days after the completion of chemotherapy, during the neutropenic phase

CT diagnosis

Caecum always involved

Management:

Nil enteral

Broad spectrum antibiotics

Granulocyte-Colony Stimulating factor

Emergency right hemicolectomy + ileostomy for:

• Perforation

• GI bleeding refractory to medical management

• Uncontrolled sepsis and deterioration

Shamberger et al 1986

Elective right hemicolectomy may be performed to prevent further episodes - but not widely practiced and may delay chemo

References

Tamma PD, Sandora TJ. Clostridium difficile Infection in Children: Current State and Unanswered Questions. J Pediatric Infect Dis Soc. 2012 Sep;1(3):230-43. doi: 10.1093/jpids/pis071. Epub 2012 Jul 25. PMID: 23687578; PMCID: PMC3656539.

Shamberger RC, Weinstein HJ, Delorey MJ, Levey RH. The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia. Cancer. 1986 Feb 1;57(3):603-9. doi: 10.1002/1097-0142(19860201)57:3<603::aid-cncr2820570335>3.0.co;2-k. PMID: 3484659.

Hirschl, Ron, et al., editors. "Neutropenic Enterocolitis." Pediatric Surgery NaT, American Pediatric Surgical Association, 2020. Pediatric Surgery Library, www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829142/all/Neutropenic Enterocolitis.