Ultraschall Med 2005; 26 - OP032
DOI: 10.1055/s-2005-917313

ANTIBIOTIC ASSOCIATED COLITIS IN CIRRHOTIC PATIENTS ON PROPHYLAXIS FOR PORTO-SYSTEMIC ENCEPHALOPATHY: ABDOMINAL ULTRASOUND FINDINGS

L Tarantino 1, A Sullo 2, IFM Sordelli 3, P Sperlongano 3
  • 1Medicine, S.Giovanni di Dio Hospital ASLNA3, Torre del Greco
  • 2Infectious Diseases, D.Cotugno Hospital
  • 3Surgery, II University of Naples, Naples, Italy

Purpose: evaluating Abdominal Ultrasound (US) as a tool for diagnosis and follow-up of antibiotic associated colitis (AAC) in cirrhotic patients.

Methods and Materials: We retrospectively studied clinical and US records of 23 (18 males; age: 47–80 years) cirrhotic patients with diagnosis of AAC. All patients were on antibiotic prophylaxis for porto-systemic encephalopathy (PSE). All patients were taking Rifaximin (1200mg daily) from 5 to 22 days (mean 11 days). 11/23 patients, because of respiratory or urinary infections, had received systemic antibiotics within 2 weeks before onset of AAC. The diagnosis of AAC was established with clinical signs (pain, fever, diarrhoea, abdominal swelling) and patients' history of antibiotic intake. All patients underwent abdominal US within 24 hours from admission. 5 patients underwent colonoscopy. All patients were treated with Metronidazole (125mg 4 times daily), Vancomycin (500mg 4 times daily) for 10 days and Piperacillin/Tazobactam (8g/1g 2 times daily) for 6 days. All patients were followed-up with US once or twice weekly during the hospitaliz

Results: Colonoscopy showed acute aspecific colitis in all 5 patients. US showed colonic wall thickening (ranging from 7 to 33mm)in all patients. 14/23 (61%) patients had colonic wall thickness <10mm while in 9/23 (39%) patients it was >10mm. Extension of inflammation was: pancolonic in 5 patients, cecum and ascending colon in 18 patients, right portion of transverse colon in 1. Ascites was present in 18/23 patients (78%).Follow-up: remission of symptoms occurred in all patients within 2–11 days (mean: 3.6 days). Normalization of colonic wall thickness (=/<4mm) at US occurred in 21 patients within 3–14 days. Persistence of symptoms was significantly longer in patients with colonic wall thickness >10mm (mean: 5.1 days) than in patients with <10mm (mean 2.5days) at US.

Conclusions: sudden worsening of cirrhotics on treatment for PSE can be associated with AAC. Thickening of colonic wall at US seems to be a reliable sign to confirm this diagnosis.