図４の左側小腸（△）で最外側の造影される薄いAは固有筋層で，やや厚い低濃度の部分Bは粘膜下浮腫で，強く造影されるCは粘膜上皮であるとされ，“target sign”を示している．▲の小腸はすべて同様な所見を呈し，広範囲小腸のびまん性急性炎症を疑う．↑はドレーン．患者はまもなく敗血症性ショック，DICと乏尿に陥ったが，血液透析とエンドトキシン吸着療法を施行し血圧と尿量が回復した．CDチェック検査で陽性を示し，CT所見を考慮し偽膜性小腸炎と診断され，バンコマイシン内服薬で治癒した．

文献考察：偽膜性小腸炎. pseudomembranous enteritis．大腸切除後に多い（表）
Clin Infect Dis. 2001 Oct 15;33(8):1429-31
Clostridium difficile small bowel enteritis occurring after total colectomy.
Freiler JF, Durning SJ, Ender PT.

Clostridium difficile infection is usually associated with antibiotic therapy and is almost always limited to the colonic mucosa. Small bowel enteritis is rare: only 9 cases have been previously cited in the literature. This report describes a case of C. difficile small bowel enteritis that occurred in a patient after total colectomy and reviews the 9 previously reported cases of C. difficile enteritis.PMID: 11565085 （full text）

参考文献
１）Dis Colon Rectum. 2000 Apr;43(4):551-4.
Pseudomembranous enteritis after proctocolectomy: report of a case.
Vesoulis Z, Williams G, Matthews B.

Intestinal pseudomembrane formation, sometimes a manifestation of antibiotic-associated diarrheal illnesses, is typically limited to the colon but rarely may affect the small bowel. A 56-year-old female taking antibiotics, who had undergone proctocolectomy for idiopathic inflammatory bowel disease, presented with septic shock and hypotension. A partial small-bowel resection revealed extensive mucosal pseudomembranes, which were cultured positive for Clostridium difficile. Intestinal drainage contents from an ileostomy were enzyme immunoassay positive for C. difficile toxin A. Gross and histopathologic features of the small-bowel resection specimen were similar to those characteristic of pseudomembranous colitis. The patient was treated successfully with metronidazole. These findings suggest a reservoir for C. difficile also exists in the small intestine and that conditions for enhanced mucosal susceptibility to C. difficile overgrowth may occur in the small-bowel environment of antibiotic-treated patients after colectomy. Pseudomembranous enteritis should be a consideration in those patients who present with purulent ostomy drainage, abdominal pain, fever, leukocytosis, or symptoms of septic shock.　PMID: 10789757

２）Arch Surg. 2006 Jan;141(1):97-9. Links
Ileal perforation secondary to Clostridium difficile enteritis: report of 2 cases.
Hayetian FD, Read TE, Brozovich M, Garvin RP, Caushaj PF.

Two cases of small-bowel perforation secondary to Clostridium difficile enteritis are described and compared with the 8 cases of C difficile enteritis reported in the medical literature. The cause of small-bowel involvement with C difficile is unknown, but prior antibiotic use, prior colectomy, chronic alterations in small-bowel flora, and other host factors are discussed.PMID: 16415419