Successfully Managed Toxic Megacolon Due to Clostridium difficile Infection in a Pheochromocytoma Patient Complicated by Cardiogenic and Septic Shock: A Case Report

Abstract

In recent years, there has been a significant rise in both the frequency and severity of Clostridium difficile colitis. This infection presents a broad clinical spectrum, ranging from asymptomatic colonization to severe fulminant colitis, which often requires urgent surgical intervention. The failure of medical treatments and the development of toxic megacolon typically necessitate surgery, though it is associated with high mortality rates. In this case, we successfully managed a rare instance of fulminant colitis in a pheochromocytoma patient with complicated cardiogenic and septic shock through conservative therapy, utilizing the standard vancomycin-metronidazole combination, supplemented with rifaximin.

Keywords: adrenal pheochromocytoma; clostridium difficile infection; sepsis; septic shock management; toxic megacolon.

Figure 1. A heterogeneous mass was in the projection of the lateral leg of the left adrenal gland and the upper pole of the left kidney. The stomach, small intestine, and large intestine up to the level of the sigmoid colon were unevenly and markedly dilated, with thickened walls, and were filled with gas and contents. Horizontal fluid and air levels are seen in some areas. Dense contents are observed in the lumen of the cecum and ascending colon. Hyperdense areas are visualized in the projection of the duodenal bulb. Paralytic ileus secondary to CDI was suspected

CDI: Clostridium difficile infection

Figure 2. The cecum, ascending colon, and transverse colon along their entire length, as well as the sigmoid colon at the loop level, are unevenly and markedly dilated, filled with gas and contents. The degree of large intestine dilation is increased compared to the previous study. The cecum is somewhat ptotic, displaced medially, compressing the uterus and urinary bladder