ABSTRACT
A 50-year-old man with a family history of bowel carcinoma was investigated for change in his bowel habit and copious mucoid stools. Blood tests showed haemoglobin 13.7g/dL, white cell count 4.3 ¥ 109/L, sodium 137mmol/L, potassium 3.0mmol/L, urea 3.9mmol/L, creatinine 98mmol/L. Tumour markers were normal and faecal occult blood was negative. Colonoscopy was performed and a 1.1cm sessile polyp was identified in the distal sigmoid colon. Histological examination showed profound dysplastic change in the epithelial component. The most likely diagnosis is:
A. Benign disease B. Villous adenoma C. Hamaratoma D. Tubular adenoma E. Carcinoid
2. Hospital-acquired infection
A postoperative patient has been moved to a side room after developing diarrhoea following the start of a course of antibiotics. Faecal samples test positive for Clostridium difficile toxin and intravenous metronidazole is started. After 10 days the antibiotic course is finished and nursing staff repeat the toxin assay on a formed stool sample, which is again positive. What is the most appropriate next management step?
