S3059 Clostridioides difficile Enteritis: A Systematic Review of Case Reports

Introduction: Clostridioides difficile enteritis (CDE) is a rare and under-recognized manifestation of C. difficile infection (CDI), affecting the small intestines. While C. difficile colitis is well-documented as a leading cause of nosocomial diarrhea, CDE remains poorly understood with current evidence limited to observational studies. Methods: Electronic databases, including PubMed, Embase, and Web of Science, were searched for published cases from inception to April 2024. Keyword terms included: “Clostridium difficile enteritis,” “Clostridioides difficile enteritis,” and “Clostridioides difficile small bowel enteritis.” Data analysis was descriptive in terms of means, ranges, proportions, and percentages. Results: The initial search yielded 2,120 articles, which were filtered using study design, English language, and human subjects. After screening for duplicates and excluding irrelevant articles, 40 articles comprising 44 patients were included in the final review. Of the 44 individual cases reviewed, 22 (50%) were male and 22 (50%) were female. The patients’ age ranged from 3.5 to 91 years, with a mean age of 52.9 years. Inflammatory bowel disease and small bowel diversion surgeries were the most common comorbid conditions. Abdominal pain and ileostomy diarrhea were the chief complaints reported in 32/44 (73%) and 19/44 (43%) cases, respectively. About 40/44 (91%) cases were effectively treated with antibiotics, while some cases required fecal microbiota transplantation or surgical exploration. Conclusion: CDE stems from overgrowth of C. difficile in the small intestine, leading to toxin-mediated mucosal injury, inflammation, and fluid secretions. Clinical manifestations are nonspecific and include abdominal pain, nausea, vomiting, and diarrhea. In rare cases, CDE can be complicated by ileus or bowel obstruction, prompting urgent surgical evaluation. Due to its rarity, complexity, and vague presentation, CDE remains a diagnostic challenge in clinical practice. Most cases are diagnosed by a combination of serology, imaging, and endoscopy. Maintaining a high index of suspicion in at-risk populations is crucial to obtain a prompt diagnosis given its high mortality rate. The management of CDE is extrapolated from standard treatments for colonic CDI, with oral vancomycin and fidaxomicin forming the mainstay of therapy. Fecal microbiota transplant (FMT) or surgical intervention may be required in severe or refractory cases.