Timing of surgery for fulminating pseudomembranous colitis

• Published in: British journal of surgery 1998-02, Vol.85 (2), p.229-231
• Main Authors: Synnott, K., Mealy, K., Merry, C., Kyne, L., Keane, C., Quill, R.
• Format: Article
• Language: English
• Subjects: Abdomen, Acute - etiology; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Clostridium difficile; Colectomy - methods; Cross Infection - epidemiology; Disease Outbreaks; Enterocolitis, Pseudomembranous - drug therapy; Enterocolitis, Pseudomembranous - epidemiology; Enterocolitis, Pseudomembranous - surgery; Female; Fever - etiology; Human bacterial diseases; Humans; Ileostomy - methods; Infectious diseases; Ireland - epidemiology; Leukocytosis - etiology; Male; Medical sciences; Multiple Organ Failure - etiology; Time Factors; Treatment Outcome
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.1365-2168.1998.00519.x

Background With increasing antibiotic usage Clostridium difficile colitis is becoming more common. Surgery for fulminating C. difficile colitis, however, is rare because of the effectiveness of specific anticlostridial chemotherapy. Surgical outcome in five patients with fulminating C. difficile colitis involved in a recent outbreak of this disease is reported. Methods Five of 138 patients developed fulminating C. difficile colitis unresponsive to medical therapy. All patients had antibiotics in the preceding period. Indications for operation in those who underwent surgery were systemic toxicity with a pyrexia, marked leukocytosis and abdominal signs leading to progressive organ failure, despite appropriate anticlostridial antibiotic therapy. Results At operation all patients had a markedly oedematous colon with normal serosa but with acute mucosal colitis. All underwent subtotal abdominal colectomy and ileostomy. Progressive organ failure persisted in four, leading to death, giving a mortality rate of four in five in the operated group in comparison with 3·8 per cent (five of 133 patients) in those treated medically. Conclusions These results indicate that this increasingly common disease frequently leads to a fatal outcome in patients requiring surgery and implies that earlier surgical consultation may be necessary to improve survival in patients with fulminating C. difficile colitis unresponsive to antibiotic therapy. © 1998 British Journal of Surgery Society Ltd