Pseudomembranous colitis complicated by toxic megacolon in oncological patients

Abstract

In recent years, information on the increase in the incidence of  infection associated with Clostridioides difficile (CDI) has appeared in the literature. It is known that C. difficile which causes pseudomembranous colitis (PMC) most often affects debilitated patients who receive treatment for the main pathology for a long time. That is why PMC is most common in cancer patients receiving long-term and aggressive anticancer treatment, which is often accompanied by the use of several courses of antibiotics. The result of the irrational use of antibiotics, incorrect PMC therapy may be the  formation of toxic megacolon, intestinal perforation, sepsis, which in turn is fraught with a fatal outcome. It is this state of affairs that aroused our interest in the study of this topic. The steady increase in the incidence of Clostridioides difficile infection makes it particularly relevant to study CDI problem in relation to cancer patients, since they most often have a wide range of risk factors for developing clostridial infection. The article presents an overview of domestic and foreign sources describing this pathology, discusses epidemiology, pathogenesis, clinical picture and current understanding of the CDI treatment. At the end of the review, we present a case of successful treatment of pseudomembranous colitis after stoma closure, which was complicated by the development of toxic megacolon. Colproctectomy was performed as part of the complex treatment of this pathology. The patient received respiratory, renal replacement, hepatoprotective, antibiotic and antifungal therapy and other treatments.