Extra-intestinal infections caused by Clostridioides difficile are exceedingly rare and typically occur in settings that disrupt the gastrointestinal barrier, including recent gastrointestinal surgery, bowel perforation or microperforation, and severe colonic disease.
We present the case of a 75-year-old man with abdominal pain and hemoperitoneum in the setting of a suspected small bowel leak secondary to an intestinal mass. Computed tomography angiography revealed an 11.0 × 9.6 cm pelvic fluid collection, prompting exploratory laparotomy with drainage of a pelvic abscess and evacuation of hemoperitoneum. Intraoperatively, a small bowel perforation caused by a 4.4 cm gastrointestinal stromal tumor (GIST) was identified. Operative anaerobic abscess cultures were monomicrobial, unexpectedly isolating Clostridioides difficile despite the absence of diarrhea or evidence of colitis on imaging. Surgical pathology confirmed a low-grade GIST with negative resection margins. Extra-intestinal C. difficile infection represents a rare but serious pathology, accounting for only a small fraction of reported C. difficile infection cases, with no published treatment guidelines. To our knowledge, extra-intestinal C. difficile abscess formation associated with small bowel GIST has rarely been reported, highlighting an unusual infectious complication of tumor-related bowel pathology.
This case underscores the importance of considering extra-intestinal C. difficile as a potential pathogen in intra-abdominal infections among patients with gastrointestinal malignancy. Early recognition may facilitate timely diagnosis, appropriate antimicrobial therapy, and improved outcomes.