Intest Res.  2016 Jan;14(1):83-88. 10.5217/ir.2016.14.1.83.

Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

• Shin JY
• Ko EJ
• Lee SH
• Shin JB
• Kim SI
• Kwon KS
• Kim HG
• Shin YW
• Bang BW

• KMID: 2174514
• DOI: http://doi.org/10.5217/ir.2016.14.1.83

Abstract

Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. Metronidazole or vancomycin is considered to be the standard therapy for the management of PMC. However, PMC has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. Here we describe a patient who experienced refractory PMC who was treated with fecal microbiota transplantation. A 69-year-old woman was admitted to the hospital with consistent abdominal pain and diarrhea, which had been present for 5 months. She was diagnosed with PMC by colonoscopy and tested positive for C. difficile toxin. Even though she took metronidazole for 10 days, followed by vancomycin for 4 weeks, her symptoms did not improve. Because of her recurrent and refractory symptoms, we decided to perform fecal microbiota transplantation. Fifty grams of fresh feces from a donor were obtained on the day of the procedure, mixed with 500 mL of normal saline, and then filtered. The filtered solution was administered to the patient's colon using a colonoscope. After the procedure, her symptoms rapidly improved and a follow-up colonoscopy showed that the PMC had resolved without recurrence.

Keyword

Clostridium difficile; Fecal microbial transplantation; Colonoscopy; Enterocolitis, pseudomembranous

MeSH Terms

Abdominal Pain
Aged
Anti-Bacterial Agents
Clostridium difficile
Colon
Colonoscopes
Colonoscopy
Diarrhea
Dysbiosis
Enterocolitis, Pseudomembranous*
Feces
Female
Follow-Up Studies
Humans
Metronidazole
Microbiota
Mortality
Opportunistic Infections
Recurrence
Tissue Donors
Vancomycin
Anti-Bacterial Agents
Metronidazole
Vancomycin

Figure

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  Fig. 1 Initial colonoscopic and pathologic findings. Colonoscopy showed multiple whitish patches on the mucosa in the transverse colon (A) and diffuse hyperemic and edematous mucosa with whitish plaques in the sigmoid colon (B). (C) Pathologic finding revealed denuded epithelium covered with inflammatory debris and neutrophils (H&E, × 40).

• 

  Fig. 2 Colonoscopic findings on the day of the procedure and fecal microbial transplantation. Colonoscopy revealed edematous and hyperemic mucosal changes with multiple whitish patches from the transverse colon to the rectum (A: descending colon, B: sigmoid colon). (C) 50 g of fresh feces were collected from the donor and then mixed and stirred with 500 mL of normal saline. That solution was then filtered using a coffee filter and/or gauze. (D) The filtered fecal solution was administered into the proximal ascending colon via a colonoscope.

• 

  Fig. 3 Colonoscopic findings one month after fecal microbial transplantation. Compared to the previous colonoscopy in this patient, mucosal edema and hyperemia was dramatically improved (A: sigmoid colon, B: A B rectum).

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