---
title: "Fulminant Clostridioides difficile Colitis After Pancreaticoduodenectomy Leading to Subtotal Colec"
id: "pubmed-42331754"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42331754"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42331754/"
doi: "10.14701/ahbps.26-057"
published_at: "2026-08-31T00:00:00.000Z"
evidence_level: "Case Reports"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Fulminant Clostridioides difficile Colitis After Pancreaticoduodenectomy Leading to Subtotal Colec
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42331754
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42331754/)
- **DOI:** [10.14701/ahbps.26-057](https://doi.org/10.14701%2Fahbps.26-057)
- **Published At:** 2026-08-31T00:00:00.000Z
- **Evidence Rating:** Case Reports
## Executive GIST (TL;DR)
- This case report describes an elderly woman with pancreatic ductal adenocarcinoma who developed **Clostridioides difficile infection (CDI)** that progressed to fulminant pseudomembranous colitis after pancreaticoduodenectomy (PD). - Preoperative risks included obstructive jaundice managed with ERCP and duodenobiliary stent placement, episodes of acute cholangitis treated with intravenous cefotaxime, and recent CDI treated with oral vancomycin that was stopped 11 days before PD. - Standard intraoperative prophylaxis used **cefazolin**; postoperative empirical cefotaxime was restarted on POD 1. - By POD 3 the patient developed profuse watery diarrhea, fever, and leukocytosis; recurrent CDI was confirmed and fidaxomicin was started promptly. - Despite intensive care and targeted therapy, she deteriorated rapidly; CT showed severe pancolitis and toxic megacolon, prompting emergency **subtotal colectomy with end ileostomy**. - Histopathology confirmed pseudomembranous colitis. The patient stabilized after surgery but remained frail; oncologic team recommended best supportive care rather than adjuvant chemotherapy. - The report emphasizes early CDI testing for postoperative diarrhea after PD and cautious perioperative antibiotic strategies in patients with recent CDI, since broad-spectrum antibiotics can precipitate fulminant recurrence. - The authors highlight that patients undergoing PD are high risk for CDI because of biliary obstruction, recurrent cholangitis, exposure to broad-spectrum antibiotics, and prolonged postoperative stays. - Figures in the article illustrate the preoperative tumor CT, CT findings of pancolitis and megacolon, and a schematic overview of high-risk patients and perioperative antibiotic recommendations. - Conflict of interest: none reported.
## Clinical Analysis & Structured Key Points
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Epub 2026 Jun 23. # Fulminant _Clostridioides difficile_ pseudomembranous colitis requiring subtotal colectomy after pancreaticoduodenectomy: A case report and mini-review [Beata Hemmelová](https://pubmed.ncbi.nlm.nih.gov/?term=Hemmelov%C3%A1+B&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#full-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Ondřej Kráčmar](https://pubmed.ncbi.nlm.nih.gov/?term=Kr%C3%A1%C4%8Dmar+O&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#full-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Jan Resler](https://pubmed.ncbi.nlm.nih.gov/?term=Resler+J&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#full-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Michal Reška](https://pubmed.ncbi.nlm.nih.gov/?term=Re%C5%A1ka+M&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#full-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Michaela Bártová](https://pubmed.ncbi.nlm.nih.gov/?term=B%C3%A1rtov%C3%A1+M&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#full-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Alena Siváková](https://pubmed.ncbi.nlm.nih.gov/?term=Siv%C3%A1kov%C3%A1+A&cauthor_id=42331754)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#full-view-affiliation-2 "Department of Microbiology, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic.") Affiliations Expand ### Affiliations * 1 First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic. * 2 Department of Microbiology, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic. * PMID: **42331754** * PMCID: [ PMC13490731 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13490731/) * DOI: [ 10.14701/ahbps.26-057 ](https://doi.org/10.14701/ahbps.26-057) Item in Clipboard Case Reports # Fulminant _Clostridioides difficile_ pseudomembranous colitis requiring subtotal colectomy after pancreaticoduodenectomy: A case report and mini-review Beata Hemmelová et al. Ann Hepatobiliary Pancreat Surg. 2026. Show details Display options Display options Format Abstract PubMed PMID Ann Hepatobiliary Pancreat Surg Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ann+Hepatobiliary+Pancreat+Surg%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ann+Hepatobiliary+Pancreat+Surg%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42331754/) . 2026 Aug 31;30(3):385-392. doi: 10.14701/ahbps.26-057. Epub 2026 Jun 23. ### Authors [Beata Hemmelová](https://pubmed.ncbi.nlm.nih.gov/?term=Hemmelov%C3%A1+B&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#short-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Ondřej Kráčmar](https://pubmed.ncbi.nlm.nih.gov/?term=Kr%C3%A1%C4%8Dmar+O&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#short-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Jan Resler](https://pubmed.ncbi.nlm.nih.gov/?term=Resler+J&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#short-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Michal Reška](https://pubmed.ncbi.nlm.nih.gov/?term=Re%C5%A1ka+M&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#short-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Michaela Bártová](https://pubmed.ncbi.nlm.nih.gov/?term=B%C3%A1rtov%C3%A1+M&cauthor_id=42331754)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#short-view-affiliation-1 "First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic."), [Alena Siváková](https://pubmed.ncbi.nlm.nih.gov/?term=Siv%C3%A1kov%C3%A1+A&cauthor_id=42331754)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42331754/#short-view-affiliation-2 "Department of Microbiology, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic.") ### Affiliations * 1 First Department of Surgery, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic. * 2 Department of Microbiology, St. Anne's University Hospital in Brno, Masaryk University, Brno, Czech Republic. * PMID: **42331754** * PMCID: [ PMC13490731 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13490731/) * DOI: [ 10.14701/ahbps.26-057 ](https://doi.org/10.14701/ahbps.26-057) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract Pseudomembranous colitis due to _Clostridioides difficile_ infection (CDI) is a serious complication of antibiotic therapy and hospitalization that can progress to toxic megacolon, necessitating emergency colectomy. Patients undergoing pancreaticoduodenectomy (PD) are particularly at high risk due to biliary obstruction, recurrent cholangitis, broad-spectrum antibiotic exposure, and prolonged postoperative stays. We report the case of an elderly woman with multiple cardiovascular comorbidities and recent CDI who underwent PD for pancreatic ductal adenocarcinoma (PDAC). Prior to surgery, she had an endoscopic retrograde cholangiopancreatography (ERCP) with duodenobiliary (DB) stent placement due to obstructive jaundice, and biopsies confirmed PDAC. Intravenous cefotaxime was initiated because of signs of acute cholangitis. She subsequently developed CDI and completed treatment with oral vancomycin, which was discontinued only 11 days before the PD. Standard prophylaxis with cefazolin was administered prior to surgery. On postoperative day (POD) 1, empirical antibiotic therapy with cefotaxime was initiated. By POD 3, she developed profuse watery diarrhea, fever, and leukocytosis, with confirmed recurrent CDI. Despite prompt fidaxomicin therapy and intensive care, she rapidly deteriorated. Computed tomography (CT) revealed severe pancolitis and toxic megacolon. Emergency subtotal colectomy with end ileostomy was performed, and histopathological examination confirmed the diagnosis. She eventually stabilized but remained frail, and the tumor board recommended best supportive care instead of adjuvant chemotherapy due to the disease stage and the severe course of CDI. This case underscores the need for early CDI testing in postoperative diarrhea following PD and for cautious perioperative antibiotic strategies in patients with recent CDI, as broad-spectrum antibiotics may precipitate fulminant recurrence. **Keywords:** Antibiotic prophylaxis; Carcinoma; Clostridioides difficile infection; Pancreaticoduodenectomy; Pseudomembranous colitis; pancreatic ductal. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported. ## Figures [ ![Fig. 1](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e341/13490731/751d644a5dbd/ahbps-30-3-385-f1.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e341/13490731/748df61a66f2/ahbps-30-3-385-f1.webp) ** Fig. 1 ** Contrast-enhanced abdominal computed tomography scan… ** Fig. 1 ** Contrast-enhanced abdominal computed tomography scan for tumor staging shows a solid heterogeneous mass… **Fig. 1** Contrast-enhanced abdominal computed tomography scan for tumor staging shows a solid heterogeneous mass in the uncinate process of the pancreatic head (black asterisk), a dilated gallbladder (white asterisk), a dilated common bile duct (black arrow), and a dilated pancreatic duct (white arrow). [ ![Fig. 2](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e341/13490731/82f6ef1fc4c8/ahbps-30-3-385-f2.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e341/13490731/25f242ff7de4/ahbps-30-3-385-f2.webp) ** Fig. 2 ** Contrast-enhanced abdominal computed tomography scan,… ** Fig. 2 ** Contrast-enhanced abdominal computed tomography scan, performed due to worsening clinical condition and signs… **Fig. 2** Contrast-enhanced abdominal computed tomography scan, performed due to worsening clinical condition and signs of developing shock, demonstrates a markedly dilated colon, particularly the cecum, with submucosal edema and mucosal enhancement. These findings, visible at the hepatic flexure, are consistent with pancolitis. (A) The transverse image. (B) The coronal image. [ ![Fig. 3](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e341/13490731/45a870f4d883/ahbps-30-3-385-f3.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e341/13490731/5f019f7a8252/ahbps-30-3-385-f3.webp) ** Fig. 3 ** Schematic overview of high-risk patients,… ** Fig. 3 ** Schematic overview of high-risk patients, perioperative antibiotic recommendations, postoperative management, and indications for… **Fig. 3** Schematic overview of high-risk patients, perioperative antibiotic recommendations, postoperative management, and indications for surgery in CDI following pancreaticoduodenectomy. CDI, _Clostridioides difficile_ infection; ATB, antibiotics; PPI, proton pump inhibitors; CT, computed tomography. [See this image and copyright information in PMC](https://pubmed.ncbi.nlm.nih.gov/42331754/) ## Similar articles * [ AGA Clinical Practice Update on Management of Clostridioides difficile Infection in Adults: Expert Review. ](https://pubmed.ncbi.nlm.nih.gov/42383946/) Fischer M, Vaughn BP, Peery AF, Kelly CR.Fischer M, et al.Clin Gastroenterol Hepatol. 2026 Sep;24(9):2359-2369. doi: 10.1016/j.cgh.2026.05.007. Epub 2026 Jul 1.Clin Gastroenterol Hepatol. 2026.PMID: 42383946Review. * [ Fulminant Clostridioides difficile Infection During Repeated High-Dose Cytarabine Consolidation for Acute Myeloid Leukemia: A Fatal Case. ](https://pubmed.ncbi.nlm.nih.gov/41737109/) Iwanaga E, Nakata H, Furuta R, Tokunaga K, Yasunaga JI.Iwanaga E, et al.Cureus. 2026 Jan 23;18(1):e102177. doi: 10.7759/cureus.102177. eCollection 2026 Jan.Cureus. 2026.PMID: 41737109Free PMC article. * [ AGA Clinical Practice Update on Management of Clostridioides difficile Infection in Inflammatory Bowel Disease: Expert Review. ](https://pubmed.ncbi.nlm.nih.gov/42138670/) Khanna S, Allegretti JR, Hashash JG, Feuerstadt P.Khanna S, et al.Gastroenterology. 2026 Jul;171(1):184-192. doi: 10.1053/j.gastro.2026.03.008. Epub 2026 May 15.Gastroenterology. 2026.PMID: 42138670Review. * [ Vesicoureteral Reflux. ](https://pubmed.ncbi.nlm.nih.gov/33085409/) Leslie SW, Aeddula NR.Leslie SW, et al.2024 Apr 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–.2024 Apr 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–.PMID: 33085409Free Books & Documents. * [ Silent Megacolon: Fulminant _Clostridioides Difficile_ Infection Without Diarrhea Mimicking Acute Colonic Pseudo-Obstruction. ](https://pubmed.ncbi.nlm.nih.gov/42222613/) Zain A, Saleem S, Yurkewicz M, Javier B, Vicknair N, Nayeem MM, Yang S, Lekkala SP.Zain A, et al.ACG Case Rep J. 2026 May 28;13(6):e02149. doi: 10.14309/crj.0000000000002149. eCollection 2026 Jun.ACG Case Rep J. 2026.PMID: 42222613Free PMC article. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42331754) ## References 1. 1. Farooq PD, Urrunaga NH, Tang DM, von Rosenvinge EC. Pseudomembranous colitis. Dis Mon. 2015;61:181–206. doi: 10.1016/j.disamonth.2015.01.006. - [DOI](https://doi.org/10.1016/j.disamonth.2015.01.006) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC4402243/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/25769243/) 2. 1. Papis D, Vagliasindi A, Maida P. Hepatobiliary and pancreatic surgery in the elderly: current status. Ann Hepatobiliary Pancreat Surg. 2020;24:1–5. doi: 10.14701/ahbps.2020.24.1.1. - [DOI](https://doi.org/10.14701/ahbps.2020.24.1.1) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC7061045/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/32181422/) 3. 1. Sumiyoshi T, Uemura K, Aoki G, Kawano R, Kitagawa H, Kondo N, et al. Increased clostridium difficile infection in the era of preoperative chemotherapy for pancreatic cancer. Pancreatology. 2022;22:258–263. doi: 10.1016/j.pan.2021.12.009. - [DOI](https://doi.org/10.1016/j.pan.2021.12.009) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/34991969/) 4. 1. Connor S. Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection. HPB (Oxford) 2016;18:642–651. doi: 10.1016/j.hpb.2016.05.006. - [DOI](https://doi.org/10.1016/j.hpb.2016.05.006) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC4972444/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/27485058/) 5. 1. Dudukgian H, Sie E, Gonzalez-Ruiz C, Etzioni DA, Kaiser AM. C. difficile colitis--pre
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