Pseudomembranous colitis without diarrhea presenting clinically as acute intestinal pseudo-obstruction

Pseudomembranous colitis usually presents with diarrhea in a clinical setti ng of recent antibiotic use. It is uncommon to see it as a cause of obstipa tion and colonic pseudo-obstruction. We report an unusual case of an elderl y woman with hypertension, congestive heart failure, chronic obstructive pu lmonary disease, chronic renal insufficiency, and diabetes mellitus, who wa s admitted with fever, abdominal pain, and distension without diarrhea. She presented with decreased stool frequency and obstipation. She did not resp ond to conservative management. Colonoscopy revealed a picture of pseudomem branous colitis, and Clostridium difficile toxin was positive. She responde d well to metronidazole therapy.