Case Report
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World J Gastrointest Surg. May 27, 2013; 5(5): 156-160
Published online May 27, 2013. doi: 10.4240/wjgs.v5.i5.156
Localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis
Ju Won Chyung, Dong Gue Shin
Ju Won Chyung, Dong Gue Shin, Department of Surgery, Seoul Medical Center, Seoul 889-5, South Korea
Author contributions: Both authors contributed to this case report.
Correspondence to: Dong Gue Shin, MD, Department of Surgery, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul 889-5, South Korea. shindoggue@naver.com
Telephone: +82-2-22768530 Fax: +82-2-22768504
Received: February 6, 2013
Revised: March 20, 2013
Accepted: March 28, 2013
Published online: May 27, 2013
Processing time: 104 Days and 3 Hours
Abstract

A 61-year-old male was admitted to our hospital due to right lower abdominal pain and watery diarrhea for 3 d. Beginning 3 wk before he arrived in our hospital, he took 3rd-generation cephalosporin (cefixime) for

2 wk due to chronic left ear otitis media. Colonoscopic examination revealed yellowish patches of ulcerations and swelling covered with thick serosanguineous exudate in the cecum and ascending colon. After 7 d of oral metronidazole treatment, his symptoms completely disappeared. We report a case of localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis associated with cefixime.

Keywords: Enterocolitis; Pseudomembranous; Appendicitis; Abdomen; Acute; Diarrhea; Cefixime

Core tip: Pseudomembranous colitis is mostly related to antibiotics, and it presents symptoms of diarrhea, abdominal pain, fever, hypoalbuminemia and hypovolemia. Diarrhea is the most common manifestation, but in geriatric patients, symptoms of pseudomembranous colitis can be different from those of usual cases, and the disease course can be more aggressive. For these reasons, it can be misdiagnosed. Therefore, physicians must consider pseudomembranous colitis in older patients with acute abdominal pain who have been treated with antibiotics. We report a case of an older patient with pseudomembranous colitis that was misdiagnosed as acute appendicitis.