Authors: Koss, K.¹; Clark, M. A.²; Sanders, D. S. A.³; Morton, D.²; Keighley, M. R. B.²; Goh, J.¹

Source: Colorectal Disease, Volume 8, Number 2, February 2006 , pp. 149-154(6)

Publisher: Wiley-Blackwell

Abstract:

Background 

The clinical presentation of Clostridium difficile infection ranges from asymptomatic carriage, colitis with or without pseudomembranes, to fulminant colitis. Although not common, fulminant C. difficile colitis can result in bowel perforation and peritonitis with a high mortality rate. Colectomy is often indicated in these cases. Methods 

We retrospectively analysed the outcome of 14 patients who underwent surgery for fulminant C. difficile colitis in the period 1996–2003 in our Unit. Results 

The indications for surgery were systemic toxicity and peritonitis (n = 10), radiological and clinical evidence of progressive toxic colonic dilatation (n = 3) and progressive colonic dilatation with bowel perforation (n = 1). C. difficile infection as the cause of colitis was diagnosed pre-operatively in seven (50%) patients, six of whom underwent a total colectomy and one a right hemicolectomy. Overall mortality in our series was 35.7%. Total colectomy was associated with a lower mortality rate of 11·1% (1/9) when compared with left hemicolectomy was 100% (4/4) (P = 0·01). One patient who underwent a right hemicolectomy (on the basis of deceptively normal external appearance of the rest of the colon intra-operatively) survived after a prolonged hospital stay. Conclusions 

Early or pre-operative microbiological diagnosis of C. difficile infection can be difficult in patients with a fulminant presentation. Those patients with C. difficile colitis, who develop signs of toxicity, peritonitis or perforation, should undergo a total colectomy as the operation of choice.

Keywords: Pseudomembranous colitis; Clostridium difficile; fulminant colitis; total colectomy

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1463-1318.2005.00876.x

Affiliations: 1: Gastrointestinal Unit 2: Academic Department of Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Birmingham 3: Department of Histopathology, South Warwickshire General Hospital NHS Trust, Warwick

Publication date: 2006-02-01

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