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Clostridioides difficile with toxic megacolon — SCE Acute Medicine MCQ

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HardAcute GI PresentationsClostridioides difficile with toxic megacolonSCE Acute Medicine

A 69-year-old man develops profuse diarrhoea and abdominal distension after piperacillin-tazobactam. Temperature is 38.9°C, pulse 124/min and white cell count is 31 x10^9/L. Abdominal radiograph shows colonic dilatation of 7 cm and stool is positive for C difficile toxin. What is the most appropriate next step in management?

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Correct answer: E — Treat as fulminant C difficile and obtain urgent surgical review

C difficile with systemic toxicity and colonic dilatation is fulminant disease with toxic megacolon risk, needing urgent antimicrobial therapy and surgical input. Loperamide can worsen colonic dilatation. Colonoscopy risks perforation and delays treatment. The pearl is that severe C difficile is a medical and surgical emergency.

Reference: NICE NG199; UKHSA C difficile guidance