| disease | Cholera-like Syndrome |
| alias | Anorectal Syndrome, Antibiotic-associated Enteritis, Postoperative Enteritis, Anbon Syndrome, Pseudomembranous Colitis |
Cholera-like (Janbon) syndrome refers to an acute necrotizing inflammation of the colon and/or small intestine, where the mucosal surface is covered with a pseudomembrane composed of fibrin, mucus, necrotic mucosa, and inflammatory cells. Hence, it is also known as pseudomembranous colitis, postoperative enteritis, antibiotic-associated enteritis, and anorectal syndrome.
bubble_chart Etiology
It is now believed that this syndrome is caused by Clostridium difficile infection, which can be induced in certain critically ill patients, trauma, surgery, stress, and the use of broad-spectrum antibiotics. The exotoxins produced by Clostridium difficile can cause coagulation in small blood vessels, thrombosis, necrosis of the intestinal wall, and even perforation; while the toxins stimulate the cAMP system in the epithelial cells of the mucous membrane, leading to cholera-like symptoms.
bubble_chart Clinical Manifestations
The main symptom is diarrhea, mostly watery with mucus. In severe cases, the daily stool output can reach 4000ml, and some patients may expel characteristic pseudomembranes. The diarrhea is not related to the dose or duration of medication. There may be gastrointestinal symptoms such as abdominal pain, nausea, and vomiting, often accompanied by fever, tachycardia, and even dehydration, shock, acidosis, delirium, and other symptoms of toxemia.
Colonoscopy reveals intestinal mucosal congestion, edema, increased fragility, ulcer bleeding, and yellowish-white or gray-green patchy pseudomembranes. Cultures for Clostridium difficile are often positive.
bubble_chart Treatment Measures
In addition to supportive symptomatic treatment, the original antibiotics should be discontinued. Probiotics such as Lactobacillus and Bifidobacterium should be used to restore normal intestinal flora. Lizhu Chang Le at a dose of 100 million units, 2.0 daily, divided into four doses, can be administered to combat Clostridium difficile, typically for 7 to 14 days. Additionally, metronidazole treatment is also effective.
bubble_chart DifferentiationIt needs to be differentiated from acute necrotizing enteritis, inflammatory bowel disease, ischemic bowel disease, and cholera.
