Spontaneous Perforation of the Colon in a Patient with Pseudomembranous Colitis: A Case Report

Pseudomembranous Colitis (PMC) is a severe inflammatory condition of the colon most commonly associated with Clostridioides Difficile Infection (CDI) and prolonged antibiotic use. Although it typically presents with diarrhea and abdominal pain, fulminant cases may lead to serious complications such as colonic necrosis and perforation, requiring prompt surgical intervention. In this case report, a 32-year-old female with a history of recurrent, self-limiting loose stools and prolonged, unsupervised antibiotic use presented with acute abdominal pain, vomiting, and distension. Radiological examination revealed signs of pneumoperitoneum, and an emergency exploratory laparotomy identified multiple colonic perforations with diffuse mucosal ulceration and necrosis. Histopathological examination of the resected specimen demonstrated classic features of PMC, including extensive transmural necrosis, crypt abscesses, epithelial sloughing, and dense neutrophilic infiltration, with no evidence of chronic Inflammatory Bowel Disease (IBD). The difficulty in diagnosing this case arose from the combination of long‑standing symptoms mimicking IBD and the absence of stool testing in the emergency setting. The case underscores the rarity of multiple colonic perforations in PMC, a feature sparsely documented in the current literature. It highlights the need for timely clinical diagnosis, early surgical decision‑making, and the importance of histopathological confirmation, particularly in patients with recurrent antibiotic exposure.