PT - JOURNAL ARTICLE AU - Vamsi Krishna Kantamaneni AU - Krishna C Gurram AU - Abhijit Kulkarni TI - <em>Clostridium difficile</em> extraintestinal abscess: a rare complication AID - 10.1136/bcr-2017-219957 DP - 2017 May 19 TA - BMJ Case Reports PG - bcr-2017-219957 VI - 2017 4099 - http://casereports.bmj.com/content/2017/bcr-2017-219957.short 4100 - http://casereports.bmj.com/content/2017/bcr-2017-219957.full AB - Extraintestinal Clostridium difficile is rare. A 74-year-old man with a history of ulcerative colitis presented after a fall. Trauma work-up showed liver cirrhosis. Two days later he developed abdominal pain, distension, diarrhoea and leucocytosis. Stool tested positive for C. difficile. CT abdomen showed pancolitis with toxic megacolon. Total abdominal colectomy and ileostomy with a rectal stump was performed. He was discharged, but was readmitted with sepsis. CT abdomen showed a 10.4×7.2 cm fluid collection in the pelvis. C. difficile stool was negative. CT-guided abscess drainage grew C. difficile. Barium enema was negative for communication from the rectal stump to the abscess. The patient was treated with metronidazole for 2 weeks. In summary, extraintestinal C. difficile can develop from recent antibiotics use, gastrointestinal surgery and microperforations from toxic megacolon. We recommend abscess drainage, concomitant treatment with metronidazole and or vancomycin, and reimaging of abscess location 2–4 weeks after cessation of antibiotics.