meropenem and Pneumoperitoneum

Various complications are reported with Clostridium difficile infection (CDI), including fulminant CDI. Fulminant CDI is an underappreciated life-threatening condition associated with complications such as toxic megacolon and bowel perforation.. A 79-year-old woman presented to the Emergency Department with altered mental status. She was admitted and conservatively treated for a left thalamic hemorrhage. While hospitalized, she developed watery diarrhea due to Clostridium difficile. Although metronidazole was initiated, she developed altered mental status and septic shock. Abdominal x-ray study and computed tomography revealed a significantly dilatated colon and a massive pneumoperitoneum. She underwent subtotal colectomy with a 14-day course of intravenous meropenem. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case suggests that we must be aware of the complications that CDI may present and adequately consider surgical management because early diagnosis and surgical treatment is critical to reduce the mortality of fulminant CDI.

Topics: Aged; Anti-Bacterial Agents; Clostridioides difficile; Clostridium Infections; Colectomy; Colon; Consciousness Disorders; Diarrhea; Female; Fever; Hemorrhage; Humans; Intestinal Perforation; Meropenem; Metronidazole; Pneumoperitoneum; Shock, Septic; Thienamycins; Tomography, X-Ray Computed

Chemotherapy of paediatric haematological malignancies can induce infectious complications of the gastrointestinal tract, with predilection of the ileocaecal region. Common causes of right lower abdominal pain in the febrile patient with neutropaenia include acute appendicitis, typhlitis, ileus and intussusception. In this case report, we describe a teenage boy with acute appendicitis presenting with pneumoperitoneum during his course of chemotherapy. The incidence, aetiology, diagnosis, investigations and management of this uncommon presentation in a common disease are discussed. The controversial topic of the management of acute appendicitis in a febrile patient with neutropaenia is also reviewed and discussed.

Topics: Abdominal Pain; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Appendectomy; Appendicitis; Child; Diagnosis, Differential; Fever; Humans; Laparoscopy; Laparotomy; Male; Meropenem; Pneumoperitoneum; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Thienamycins; Treatment Outcome

Emphysematous cystitis is a potentially life-threatening condition characterized by the amassing of gas within the wall of the bladder, as a result of infection by gas-forming organisms. However, the amassing of gas in the wall of the bladder does not always result from an infectious etiology. Here we report the case of a patient diagnosed with lung cancer and treated with chemotherapy, where there was air within the bladder wall accompanied by pneumoperitoneum. The presence of an infectious etiology was not clear, and the patient responded successfully to medical treatment. Although emphysematous cystitis is the most common diagnosis, the presence of gas within the wall of the bladder is a sign and not a disease per se. In our opinion, the case displays similar characteristics to those of pneumatosis cystoides intestinalis, and for this reason we refer to it as bladder pneumatosis.

Topics: Aged; Anti-Bacterial Agents; Cystitis; Emphysema; Female; Granulocyte Colony-Stimulating Factor; Humans; Leukopenia; Lung Neoplasms; Meropenem; Pneumoperitoneum; Radiography; Thienamycins