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. 1977 Jan;30(1):1–12. doi: 10.1136/jcp.30.1.1

Pseudomembranous colitis.

A B Price, D R Davies
PMCID: PMC476619  PMID: 838865

Abstract

Three basic histopathological patterns which may be seen in rectal biopsies from patients with pseudomembranous colitis are described, based on a study of 29 cases. The spectrum of change is illustrated and the problems of differential diagnosis are discussed--from a non-diagnostic proctitis at one extreme to acute ischaemia at the other. In the differential diagnosis of the acute colitic, the importance of urgent rectal biopsy and a carefully taken drug history is stressed. The association of pseudomembranous colitis with pre-existing disease and antibiotic therapy is confirmed. It is suggested that these cause local mucosal damage and may trigger the first part of a local Shwartzman reaction. Capillary microthrombosis may then paly a part in producing the mucosal necrosis seen later in the disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cohen L. E., McNeill C. J., Wells R. F. Clindamycin-associated colitis. JAMA. 1973 Mar 19;223(12):1379–1380. [PubMed] [Google Scholar]
  2. DRUCKER W. R., DAVIS J. H., HOLDEN W. D., REAGAN J. R. HEMORRHAGIC NECROSIS OF THE INTESTINE. A CLINICAL SYNDROME: PRESENCE WITHOUT ORGANIC VASCULAR OCCLUSION. Arch Surg. 1964 Jul;89:42–53. doi: 10.1001/archsurg.1964.01320010044006. [DOI] [PubMed] [Google Scholar]
  3. Gibson G. E., Rowland R., Hecker R. Diarrhoea and colitis associated with antibiotic treatment. Aust N Z J Med. 1975 Aug;5(4):340–347. doi: 10.1111/j.1445-5994.1975.tb03269.x. [DOI] [PubMed] [Google Scholar]
  4. Goulston S. J., McGovern V. J. Pseudo-membranous colitis. Gut. 1965 Jun;6(3):207–212. doi: 10.1136/gut.6.3.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Groll A., Vlassembrouck M. J., Ramchand S., Valberg L. S. Fulminating noninfective pseudomembranous colitis. Gastroenterology. 1970 Jan;58(1):88–95. [PubMed] [Google Scholar]
  6. HARDAWAY R. M., 3rd, McKAY D. G. Pseudomembranous enterocolitis; are antibiotics wholly responsible. AMA Arch Surg. 1959 Mar;78(3):446–457. [PubMed] [Google Scholar]
  7. HJORT P. F., RAPAPORT S. I. THE SHWARTZMAN REACTION: PATHOGENETIC MECHANISMS AND CLINICAL MANIFESTATIONS. Annu Rev Med. 1965;16:135–168. doi: 10.1146/annurev.me.16.020165.001031. [DOI] [PubMed] [Google Scholar]
  8. Jackson B. T., Anders C. J. Idiopathic pseudomembranous colitis successfully treated by surgical excision. Br J Surg. 1972 Feb;59(2):154–156. doi: 10.1002/bjs.1800590222. [DOI] [PubMed] [Google Scholar]
  9. KAY A. W., RICHARDS R. L., WATSON A. J. Acute necrotizing (pseudomembranous) enterocolitis. Br J Surg. 1958 Jul;46(195):45–57. doi: 10.1002/bjs.18004619509. [DOI] [PubMed] [Google Scholar]
  10. Le Frock J. L., Klainer A. S., Chen S., Gainer R. B., Omar M., Anderson W. The spectrum of colitis associated with lincomycin and clindamycin therapy. J Infect Dis. 1975 May;131 (Suppl):S108–S115. doi: 10.1093/infdis/131.supplement.s108. [DOI] [PubMed] [Google Scholar]
  11. Margaretten W., McKay D. G. Thrombotic ulcerations of the gastrointestinal tract. Arch Intern Med. 1971 Feb;127(2):250–253. [PubMed] [Google Scholar]
  12. Marr J. J., Sans M. D., Tedesco F. J. Bacterial studies of Clindamycin-associated colitis. A preliminary report. Gastroenterology. 1975 Aug;69(2):352–358. [PubMed] [Google Scholar]
  13. Marston A., Pheils M. T., Thomas M. L., Morson B. C. Ischaemic colitis. Gut. 1966 Feb;7(1):1–15. doi: 10.1136/gut.7.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. McGovern V. J., Goulston S. J. Ischaemic enterocolitis. Gut. 1965 Jun;6(3):213–220. doi: 10.1136/gut.6.3.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. McKAY D. G., HARDAWAY R. M., 3rd, WAHLE G. H., Jr, HALL R. M. Experimental pseudomembranous enterocolitis; production by means of thrombosis of intestinal mucosal capillaries. AMA Arch Intern Med. 1955 Jun;95(6):779–787. doi: 10.1001/archinte.1955.00250120015002. [DOI] [PubMed] [Google Scholar]
  16. Ming S. C. Hemorrhagic necrosis of the gastrointestinal tract and its relation to cardiovascular status. Circulation. 1965 Sep;32(3):332–341. doi: 10.1161/01.cir.32.3.332. [DOI] [PubMed] [Google Scholar]
  17. Robinson J. W., Rausis C., Basset P., Mirkovitch V. Functional and morphological response of the dog colon to ischaemia. Gut. 1972 Oct;13(10):775–783. doi: 10.1136/gut.13.10.775. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Schapiro R. L., Newman A. Acute enterocolitis. A complication of antibiotic therapy. Radiology. 1973 Aug;108(2):263–268. doi: 10.1148/108.2.263. [DOI] [PubMed] [Google Scholar]
  19. Scott A. J., Nicholson G. I., Kerr A. R. Lincomycin as a cause of pseudomembranous colitis. Lancet. 1973 Dec 1;2(7840):1232–1234. doi: 10.1016/s0140-6736(73)90973-2. [DOI] [PubMed] [Google Scholar]
  20. Smart R. F., Ramsden D. A., Gear M. W., Nicol A., Lennox W. M. Severe pseudomembranous colitis after lincomycin and clindamycin. Br J Surg. 1976 Jan;63(1):25–29. doi: 10.1002/bjs.1800630106. [DOI] [PubMed] [Google Scholar]
  21. Steer H. W. The pseudomembranous colitis associated with clindamycin therapy--a viral colitis. Gut. 1975 Sep;16(9):695–706. doi: 10.1136/gut.16.9.695. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sumner H. W., Tedesco F. J. Rectal biopsy in clindamycin-associated colitis. An analysis of 23 cases. Arch Pathol. 1975 May;99(5):237–241. [PubMed] [Google Scholar]
  23. Tedesco F. J., Barton R. W., Alpers D. H. Clindamycin-associated colitis. A prospective study. Ann Intern Med. 1974 Oct;81(4):429–433. doi: 10.7326/0003-4819-81-4-429. [DOI] [PubMed] [Google Scholar]
  24. Viteri A. L., Howard P. H., Dyck W. P. The spectrum of lincomycin-clindamycin colitis. Gastroenterology. 1974 Jun;66(6):1137–1144. [PubMed] [Google Scholar]
  25. WILSON R., QUALHEIM R. E. A form of acute hemorrhagic enterocolitis afflicting chronically ill individuals; a description of twenty cases. Gastroenterology. 1954 Oct;27(4):431–444. [PubMed] [Google Scholar]
  26. Whitehead R. Ischaemic enterocolitis: an expression of the intravascular coagulation syndrome. Gut. 1971 Nov;12(11):912–917. doi: 10.1136/gut.12.11.912. [DOI] [PMC free article] [PubMed] [Google Scholar]

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