Clostridial toxins in strangulation obstruction and antibiotic-related colitis.

Clostridial toxins have previously been implicated in both strangulation obstruction and antibioticassociated colitis. These experiments show that these toxins are identical or similar in both diseases. Eighteen dogs with strangulation obstruction were studied. Closed midjejunal loops were constructed and bowel continuity was reestablished by end-to-end anastomosis. Venous blood supply to the closed loop was divided and ligated. Twelve dogs were sacrificed 18 hr later when specimens of blood, loop fluid, and bowel wall were obtained for cultures; the remaining animals were sacrificed at 3 hr and served as operative controls. Half of the dogs received 1 g of vancomycin 1 day before and 1 hr before operation. Clostridia were isolated from the loop fluids in all but four of nine dogs that had received vancomycin. Bacteria-free loop fluids injected intracecally into hamsters caused diarrhea and colitis as did bacteria-free filtrates of Clostridium sordellii broth cultures isolated from the dogs. The animals pretreated with vancomycin showed ischemic changes in their obstructed bowel loops but their loop fluid was not toxic to hamsters. No vancomycin-treated animals had positive blood cultures, whereas six of nine non-vancomycin-treated dogs grew Clostridium spp. from their blood. These experiments show similarities between the toxins involved in these two diseases and suggest that modalities useful in identifying and treating antibiotic-associated colitis may be applicable to cases of strangulation obstruction.