Search Our Scientific Publications & Authors

Masui 2017 May;66(5):503-507

Point-of-care ultrasound (POCUS) in the diagnoses of postoperative complications is discussed. POCUS is useful in many situations such as abdominal distension, elevated liver enzymes, abdominal pain, and fever, which are the common complications encountered after surgical operations. In the patients with abdominal distention, bowel distention or ascites can be easily detected by POCUS. Read More

Radiologe 2018 Apr;58(4):302-311

Klinik für diagnostische und interventionelle Radiologie und Neuroradiologie, Clemenshospital Münster, Düesbergweg 124, 48153, Münster, Deutschland.

Background: Computed tomography (CT) is often used as the initial diagnostic test in patients with inflammatory and infectious types of enterocolitis. The differential diagnosis is broad, including infectious, non-infectious and vascular causes, which have substantially different management strategies. Although a definitive diagnosis often relies on endoscopic biopsy results, stool culture results or other clinical features, radiologists often help to guide the diagnosis. Read More

Gastroenterology 2018 08 2;155(2):e11-e12. Epub 2018 Feb 2.

Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Alabama.

BMJ Case Rep 2018 Jan 26;2018. Epub 2018 Jan 26.

Imaging Department, Barts Health NHS Trust, London, UK.

While imaging appearances of pseudomembranous colitis are commonly recognised, radiological manifestations of -associated enteritis are poorly understood which, combined with the rarity of this infection involving small bowel, makes establishing the correct diagnosis challenging. Therefore, in order to encourage awareness of readers, we present a case of enteritis that manifested as abdominal sepsis complicating the postoperative period in a middle-aged woman with fistulating Crohn's disease and defunctioning ileostomy. Radiological appearances are described based on three consecutive CT studies performed 5 days prior to onset of symptoms, during the peak of enteritis, corresponding with the patient's clinical deterioration, and also 35 days later following treatment and resolution. Read More

Medicine (Baltimore) 2017 Aug;96(33):e7793

aDivision of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz bDivision of General Pediatrics and Adolescent Medicine, Hospital Wels-Grieskirchen, Wels cMicrobiologic Laboratory, Institute of Pathology, General Hospital Hochsteiermark, Leoben dInstitute of Pathology, Medical University Graz, Graz eDivision of Pediatrics and Adolescent Medicine fInstitute of Microbiology, Medical University Innsbruck, Innsbruck gDivision of Pediatrics and Adolescent Medicine, General Hospital Hochsteiermark, Leoben hInstitute of Pathology, Hospital Oberwart, Oberwart iDepartment of Internal Medicine, Medical University Graz jInstitute of Hygiene, Microbiology and Environmental Medicine kDivision of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University Graz lInstitute of Molecular Biosciences, Karl-Franzens University Graz, Graz mDivision of Pediatrics and Adolescent Medicine, Hospital Oberwart, Oberwart nDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University Graz, Graz, Austria.

Diseases causing hematochezia range from benign to potentially life-threatening. Systematic pediatric data on the causes of hematochezia are scarce. We studied the underlying causes and long-term outcome of hematochezia in children. Read More

Rev Esp Enferm Dig 2017 Sep;109(9):670

Aparato Digestivo, Hospital Universitario de Cabueñes.

Clostridium difficile (CD) infection is currently the most frequent etiology of nosocomial diarrhea. Besides, its incidence is progressively increasing in ambulatory patients. Inflammatory bowel disease (IBD) is a risk factor of CD infection itself, but also due to the regular immunosuppressive treatment used in these patients. Read More

BMJ Case Rep 2017 Jun 18;2017. Epub 2017 Jun 18.

Department of Anaesthetics, Cheltenham General Hospital, Cheltenham, UK.

A 75-year-old man was admitted with abdominal pain and fresh rectal bleeding. Significantly, he had no risk factors for infection. An abdominal CT demonstrated colonic thickening, and flexible sigmoidoscopy identified pseudomembranous colitis-like lesions. Read More

Curr Drug Saf 2017 ;12(3):205-207

CM 31/13, Shantinagar 2, Near Bhagwati Circle, Kalvibid, Bhavnagar-364002, Gujarat. India.

Introduction: Incidence of antibiotic- associated diarrhoea is a common (10-30%) but pseudomembranous colitis (PMC) is less frequent (1-5%). Fluoroquinolones, clindamycin, penicillins, cephalosporins (mostly third generation) are commonly associated with PMC. The association between cephalosporins and PMC is now well established. Read More

World J Gastroenterol 2017 Apr;23(16):3003-3010

Wolfgang Kreisel, Bertram Bengsch, Anna-Maria Globig, Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.

Protein-losing enteropathy (PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or pericardial effusion and/or malnutrition. In most cases the site of protein loss is the small intestine. Read More

Rev Gastroenterol Mex 2017 Oct - Dec;82(4):301-308. Epub 2017 Mar 29.

Servicio de Infectología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México; Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.

Introduction And Aims: Clostridium difficile infection is the main cause of hospital-acquired diarrhea, and the clinical and endoscopic findings in those patients have been studied very little in Mexico. The aim of the present study was to describe those findings.

Materials And Methods: A prospective cohort study was conducted that included patients with hospital-acquired diarrhea associated with Clostridium difficile diagnosed through polymerase chain reaction. Read More

N Z Med J 2017 Mar 24;130(1452):68-70. Epub 2017 Mar 24.

Department of General Medicine, North Shore Hospital, Waitemata DHB, Auckland.

Case report of a 23-year-old male presenting with a severe flare of Crohn's disease, exacerbated by community-acquired infection with Clostridium difficile. This case outlines the association between C. difficile infection and inflammatory bowel disease, as both a mimic and a precipitant of flares. Read More

Z Gerontol Geriatr 2016 Dec 26;49(8):743-761. Epub 2016 Oct 26.

Medizinische Klinik 2, Schwerpunkt Geriatrie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, 90419, Nürnberg, Deutschland.

Clostridium difficile is the main cause of nosocomial antibiotic-associated diarrhea in adults in Europe and North America. Infections with C. difficile typically occur in elderly patients with comorbidities and prior antibiotic therapy. Read More

Rev Esp Enferm Dig 2016 Oct;108(10):659-600

Aparato Digestivo, Hospital Univ. Río Hortega. Valladolid.

An 82-year-old male with a history of high blood pressure, COPD, chronic myeloid leukemia, and stage-4 chronic renal failure. Admitted to hospital for lower-limb cellulitis and severe COPD exacerbation, he received antibiotic therapy and bronchodilators. During his hospital stay he developed severe anemia and had an hematochezia event with no diarrhea. Read More

Tex Heart Inst J 2016 Apr 1;43(2):168-70. Epub 2016 Apr 1.

A 69-year-old man presented with a progressively enlarging pulsatile mass in the left side of his chest. Because of a history of an ischemic cardiomyopathy, he had been randomized in 2003 to undergo coronary artery bypass grafting with a Dor procedure, as part of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Our patient's imaging studies, including a thoracic computed tomogram and transthoracic echocardiogram, were now of concern for left ventricular pseudoaneurysm. Read More

BMJ Case Rep 2016 Feb 22;2016. Epub 2016 Feb 22.

Department of Medicine, Division of Infectious Diseases, University of Florida, Gainesville, Florida, USA.

This is a case of a 63-year-old, post total colectomy patient, who presented to the hospital with watery diarrhoea, abdominal cramping and fevers. On admission, the patient was haemodynamically stable and febrile. Clostridium difficile PCR was sent and tested positive. Read More

Rinsho Byori 2015 Jun;63(6):717-24

In this paper, abdominal ultrasound examination as a point-of-care examination (POCUS) is discussed. POCUS is very useful in various clinical situations, especially for the diagnosis of critically ill patients with non-specific symptoms. In patients with an unknown fever origin, POCUS can detect unexpected infection foci such as liver abscesses. Read More

Dig Dis Sci 2016 09;61(9):2488-91

Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA.

Eur J Radiol 2016 Jan 9;85(1):286-290. Epub 2015 Oct 9.

Diagnostic Imaging, Royal Preston Hospital, Sharoe Green Lane, Preston, Lancashire PR2 9HT, UK. Electronic address:

Purpose: To assess T2 HASTE MR in acute abdominal imaging and ascertain if it is a reliable alternative to CT in patients under 60.

Method And Materials: In a prospective diagnostic performance study from January 2009 to December 2013, patients under 60 presenting with acute abdominal pain, that required imaging following surgical review, were imaged with T2 HASTE MR. Rapid acquisition HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo) coronal and axial sequences were obtained, without intravenous contrast. Read More

Radiol Clin North Am 2015 Nov 12;53(6):1255-71. Epub 2015 Aug 12.

Section of Abdominal Imaging, Imaging Institute, Digestive Disease Institute and Cancer Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, L10, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address:

Infectious and inflammatory enterocolitides can present with an acute abdomen. The most common entities are ulcerative colitis, Crohn disease, and Clostridium difficile colitis. This article reviews the clinical and imaging findings of patients who present acutely with infectious and inflammatory enterocolitides. Read More

Perit Dial Int 2015 Sep-Oct;35(5):586-7

University of Rochester Medical Center, Rochester, NY, USA.

West J Emerg Med 2015 May 2;16(3):422-3. Epub 2015 Apr 2.

University of Louisville, Department of Pulmonary, Critical Care, and Sleep Disorders Medicine, Louisville, Kentucky.

J Infect Dis 2015 Aug 24;212(4):654-63. Epub 2015 Mar 24.

Department of Medical Laboratory Science and Biotechnology Center of Infectious Disease and Signaling Research, National Cheng Kung University.

Background: Clostridium difficile is currently the leading cause of infectious diarrhea in hospitalized patients. In addition to the infection due to toxigenic C. difficile in the gastrointestinal tract of susceptible hosts, other predisposing factors for C. Read More

J Clin Neurosci 2015 Jul 18;22(7):1199-200. Epub 2015 Mar 18.

Department of Neurology, University of Pittsburgh Medical Center, Kaufmann Medical Building Suite 811, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Electronic address:

We report a 37-year-old man with a history of cirrhosis and methicillin-sensitive staphylococcus aureus (MSSA) bacteremia who presented from a nursing home with 1 week of progressive confusion followed by acute onset of aphasia, forced left eye deviation and right sided weakness. While clinical presentation was concerning for a left middle cerebral artery stroke, MRI was consistent with leukoencephalopathy. The man had been on metronidazole for 2 months for treatment of Clostridium difficile infection. Read More

JAMA Intern Med 2015 Apr;175(4):489-90

Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada4Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Cell Res 2015 Feb 30;25(2):157-68. Epub 2014 Dec 30.

Biodynamic Optical Imaging Center (BIOPIC), State Key Laboratory of Protein and Plant Gene Research, School of Life Sciences, Peking University, Beijing 100871, China.

As a gram-positive, spore-forming anaerobic bacillus, Clostridium difficile (C. difficile) is responsible for severe and fatal pseudomembranous colitis, and poses the most urgent antibiotic resistance threat worldwide. Epidemic C. Read More

BMJ Case Rep 2014 Dec 17;2014. Epub 2014 Dec 17.

Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands.

A 78-year-old woman with long-standing obstipation presented herself to the hospital with diarrhoea and progressive abdominal cramping since 2 days. Acute abdomen developed and an emergency exploratory laparotomy was indicated, which showed no signs of bowel ischaemia. After admission to the internal ward, stool Clostridium difficile PCR was tested positive. Read More

Toxicology 2015 Feb 11;328:48-56. Epub 2014 Dec 11.

Department of Neurology, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany. Electronic address:

Clostridium difficile toxins A and B (TcdA and TcdB) belong to the class of large clostridial cytotoxins and inactivate by glucosylation some low molecular mass GTPases of the Rho-family (predominantly Rho, Rac and Cdc42), known as regulators of the actin cytoskeleton. TcdA and B also represent the main virulence factors of the anaerobic gram-positive bacterium that is the causal agent of pseudomembranous colitis. In our study, TcdB was chosen instead of TcdA for the well-known higher cytotoxic potency. Read More

Am J Gastroenterol 2014 Dec;109(12):1956-7

Division of Digestive Diseases, Emory University, Atlanta, Georgia, USA.

Case Rep Med 2014 18;2014:812704. Epub 2014 Aug 18.

Division of Gastroenterology & Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

Although classically pseudomembranous colitis is caused by Clostridium difficile, it can result from several etiologies. Certain medications, chemical injury, collagenous colitis, inflammatory bowel disease, ischemia, and other infectious pathogens can reportedly cause mucosal injury and subsequent pseudomembrane formation. We present the case of a middle-aged woman with vascular disease who was incorrectly diagnosed with refractory C. Read More

BMJ Case Rep 2014 Feb 13;2014. Epub 2014 Feb 13.

Department of Obstetrics and Gynaecology, University Hospital Coventry & Warwickshire, Coventry, UK.

An 81-year-old woman presented with a history of severe chronic diarrhoea resulting in an admission with syncope and electrolyte abnormalities. Imaging studies of the bowel were normal. However, biopsies taken during colonoscopy enabled a diagnosis to be made and effective treatment to be initiated. Read More

Indian J Pathol Microbiol 2013 Oct-Dec;56(4):413-5

Departments of Pathology & Medical Gastroenterology, Bahrain Specialist Hospital, Juffair, Manama, Bahrain.

A 71-year-old female patient was admitted with intractable diarrhea and abdominal distention following several courses of broad spectrum antibiotic therapy. Colonic biopsy revealed pseudomembranous colitis with foci of signet ring cell (SRC) change. The SRCs possessed bland nuclei and were confined to the basement membranes of the crypts with no infiltration into the lamina propria. Read More

Chest 2014 Jan;145(1):158-165

Section of Pulmonary & Critical Care Medicine, Department of Medicine, LSU Health Sciences Center, New Orleans, LA. Electronic address:

Disorders of elevated body temperature may be classified as either fever or hyperthermia. Fever is caused by a pyrogen-mediated upward adjustment of the hypothalamic thermostat; hyperthermia results from a loss of physiologic control of temperature regulation. Fever in the ICU can be due to infectious or noninfectious causes. Read More

Diagn Interv Imaging 2013 Jul-Aug;94(7-8):793-804. Epub 2013 Jun 7.

Urinogenital and Digestive Imaging Department, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.

Acute colitis is an acute condition of the colon. For the radiologist, it is mainly diagnosed during differential diagnosis of acute abdominal conditions. There are many causes of colitis and the degree of its severity varies. Read More

J Med Assoc Thai 2013 Apr;96(4):477-84

Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Background: Pancolonic colonic wall thickening is a common CTfeature in patients diagnosed with Clostridium difficile colitis (CDC).

Objective: To illustrate CT appearances of CDC in hospitalized patients with toxin assay indicant or endoscopic proven CDC.

Material And Method: Two reviewers independently evaluated the colonic abnormalities in the retrospectively identified patients with toxin assay indicant or endoscopic proven CDC that underwent abdominal CT between January 2006 and June 2009. Read More

BMJ Case Rep 2013 Apr 17;2013. Epub 2013 Apr 17.

Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.

Typhlitis or neutropenic enterocolitis (NEC) is a life-threatening condition that occurs in neutropenic patients. Early recognition is crucial owing to high death rate. We present a case of a 54-year-old man, diagnosed with non-Hodgkin lymphoma who received a first cycle of rituximab, cyclophosphamide, hydroxydaunorubicin (doxorubicin), oncovin (vincristine), prednisolone (R-CHOP) chemotherapy 10 days prior presenting. Read More

J Clin Gastroenterol 2013 May-Jun;47(5):426-31

Gastroenterology Center of Connecticut, Hamden, CT 06518, USA.

Background: Studies have suggested that colonic diverticulosis might increase the likelihood of repeat Clostridium difficile infection (CDI). Our study was designed to compare rates of repeat infection in patients with and without colon diverticula.

Methods: Patients who had a positive C. Read More

J La State Med Soc 2012 Sep-Oct;164(5):265-7

Louisiana State University Health Sciences Center, Shreveport School of Medicine, Shreveport, USA.

Acute appendicitis is a common cause for pediatric surgery, with an increasing incidence as this population ages. Pseudomembranous colitis (PMC) from Clostridum difficle is being seen more frequently in pediatric patients, especially after treatment with antibiotics and in those with Hirschsprung's disease. Only three prior cases of appendicitis associated with PMC have been described in the literature, and all of them occurred in adult patients. Read More

BMJ Case Rep 2013 Jan 22;2013. Epub 2013 Jan 22.

Department of General Surgery, Severn Deanery, Gloucester, UK.

A fit and well 16-year-old girl presented to the emergency department with signs and symptoms suggestive of appendicitis. A transabdominal ultrasound scan revealed a normal appendix but there was significant free fluid in the pelvis. Consequently, a CT scan of her abdomen was performed which showed mucosal oedema and inflammation involving virtually the entire length of her large bowel (the 'accordion sign'). Read More

Clin Nucl Med 2013 Feb;38(2):e101-2

Department of Nuclear Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India.

Labeled leukocyte scintigraphy and (18)F-FDG PET are well-documented techniques for the assessment of inflammatory bowel disease. In this study, a 28-year-old man with abdominal pain, vomiting, and raised serum amylase and lipase levels underwent PET/CT imaging using FDG-labeled autologous leukocytes to assess for pancreatic infection. While the pancreas showed no abnormal tracer uptake, colonic inflammation was incidentally detected, and a diagnosis of pseudomembranous colitis was subsequently confirmed on colonoscopy and biopsy. Read More

Orv Hetil 2012 Dec;153(52):2077-83

Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Belgyógyászati Intézet.

Due to world-wide spread of hypervirulent and antibiotic resistant Clostridium difficile strains, the incidence of these infections are dramatically increasing in Hungary with appalling mortality and recurrence rates. Authors present a case of a 59-year-old patient who developed a severe, relapsing pseudomembranous colitis after antibiotic treatment. Life-threatening symptoms of fulminant colitis were successfully treated with prolonged administration of metronidazole and vancomycin, careful supportive therapy and weeks of intensive care. Read More

Curr Opin Gastroenterol 2013 Jan;29(1):39-41

BMJ Case Rep 2012 Oct 30;2012. Epub 2012 Oct 30.

Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.

A 65-year-old man with long-standing diarrhoea, recurrent Clostridium difficile infection (CDI) in the previous 5 months presented to the gastroenterology clinic with recurrent diarrhoea and abdominal cramping. Physical examination was negative for signs of acute abdomen. Stool C difficile PCR was positive. Read More

World J Gastroenterol 2012 Aug;18(32):4447-9

Medical ClinicI, University of Erlangen-Nuremberg, 91054 Erlangen, Germany.

Histiocytes have a pivotal role in wound repair and intestinal epithelial recovery - the most important goal to sustain gut functionality. Yet, an in vivo description of colonic histiocytes by confocal laser endomicroscopy (CLE) is missing. Here, we report the case of a 45-years-old male patient who was referred to our clinic with weight loss and a history of two consecutive Clostridium difficile colitis episodes, the latter cured 3 wk before present admission. Read More

J Cyst Fibros 2013 Jan 19;12(1):92-6. Epub 2012 Jun 19.

Section of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.

Objective: To examine the incidence of recurrent Clostridium difficile infection in patients with cystic fibrosis (CF), including patients who had undergone lung transplantation, and review clinical findings in hospitalized patients with C. difficile colitis.

Methods: A retrospective chart review was performed to examine the clinical presentation and management of patients with cystic fibrosis (CF) who received care at the University of Wisconsin Hospital and Clinics (UWHC) from 1994 to 2011 and were prospectively identified with C. Read More

BMJ Case Rep 2012 May 8;2012. Epub 2012 May 8.

Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA.

Clostridium difficile infection is the most common infectious cause of healthcare-acquired diarrhoea. Severe infections cause therapeutic challenges for healthcare providers. Various novel treatment modalities are currently being explored for treatment of severe disease. Read More

Cancer Imaging 2012 May 7;12:163-72. Epub 2012 May 7.

Division of Diagnostic Imaging, UT MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1473, PO Box, Houston, TX 77030, USA.

Treatment of cancer involves a multidisciplinary approach consisting of surgery, chemotherapy, molecular targeted therapy and radiation therapy. These therapies work on the tumor cells to result in cell stasis or cell death. The same mechanism can result in toxicity to the normal gastrointestinal tract. Read More

Clin Pediatr (Phila) 2012 Dec 7;51(12):1197-201. Epub 2012 Feb 7.

The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ 08901, USA.

Surg Infect (Larchmt) 2011 Dec 5;12(6):501-6. Epub 2011 Dec 5.

Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.

Background: Clostridial myonecrosis is an uncommon, highly lethal necrotizing soft tissue infection. The source may be occult at the time of clinical presentation. In cases caused by Clostridium septicum, there is an association with colorectal malignant disease, suggesting that underlying colonic pathology frequently is the source of the infection. Read More

J Hosp Infect 2011 Oct 17;79(2):151-4. Epub 2011 Aug 17.

Department of Medicine, Danbury Hospital, Danbury, CT, USA.

Clostridium difficile is a common cause of nosocomial diarrhoea in the USA. To develop a score model that would help to identify severe versus mild or moderate C. difficile infection (CDI) upon admission we performed a retrospective cohort study. Read More

N Engl J Med 2011 Feb;364(5):e8

Mackay Memorial Hospital, Taipei, Taiwan.