Pseudomembranous Colitis Presenting with Dual Colonic Perforation in a 115-year-old Girl: A Rare Case Rreport

Background: Pseudomembranous colitis (PMC) is an undesirable complication of Clostridium difficile infection. Although it is a part of normal gut flora, C. difficile can become a nuisance and cause varying degrees of colitis, given the opportunity of a conducive host environment. Even though most patients have mild colitis and abdominal pain, a few develop PMC, particularly immunocompromised and debilitated hosts. Pseudomembranous colitis is managed medically with metronidazole or vancomycin, fluids, and nutritional support. It can progress to toxic megacolon in up to 3% of cases. Toxic megacolon warrants a subtotal or total colectomy after a short trial of medical management. This dire complication is associated with a high mortality rate regardless of surgical intervention. Case Presentation: A 15-year-old otherwise healthy patient presented with perforative peritonitis and septic shock. The patient did not have any significant past medical history. The patient was resuscitated and started on inotropes. An abdominal X-ray revealed gas under the diaphragm, with ultrasonography suggesting free fluid in the abdomen. Owing to the poor general condition of the patient, abdominal drains were inserted under local anesthesia. The patient was explored after 48 hours after fluid and electrolyte correction and antibiotic therapy. On exploratory laparotomy, the patient had dual colonic perforations. Despite best efforts at resuscitation, the patient died on postoperative day 3. Pathological analysis of the specimen suggested the presence of PMC throughout the resected segment of the colon. Conclusion: We suggest considering PMC as a differential diagnosis in a complicated toxic megacolon, regardless of the patient’s age, duration of antibiotic therapy, and underlying diagnosis, particularly when there is an obscure history and diagnostic uncertainty.