Decompressive colonoscopy with intracolonic vancomycin administration for the treatment of severe pseudomembranous colitis

Background: We explored the potential of early decompressive colonoscopy wi th intracolonic vancomycin administration as an adjunctive therapy for seve re pseudomembranous Clostridium difficile colitis with ileus and toxic mega colon. Methods: We reviewed the symptoms, signs, laboratory tests, radiographic fi ndings, and outcomes from the medical records of seven patients who experie nced eight episodes of severe pseudomembranous colitis with ileus and toxic megacolon. All seven patients underwent decompressive colonoscopy with int racolonic perfusion of vancomycin. Results: Fever, abdominal pain, diarrhea, abdominal distention, and tendern ess were present in all patients. Five of seven patients were comatose, obt unded, or confused, and six of the seven required ventilatory support. The white blood cell count was greater than 16,000 in seven cases (six patients ). Colonoscopy showed left-side pseudomembranous colitis in one patient, ri ght-side colitis in one patient, and diffuse pseudomembranous pancolitis in five patients. Two patients were discharged with improvement. Five patient s had numerous medical problems leading to their death. Complete resolution of pseudomembranous colitis occurred in four patients. One patient had a p artial response, and two patients failed therapy. Conclusion: Colonoscopic decompression and intracolonic vancomycin administ ration in the management of severe, acute, pseudomembranous colitis associa ted with ileus and toxic megacolon is feasible, safe, and effective in appr oximately 57% to 71% of cases.