Diverting Loop Ileostomy for Clostridium Difficile Colitis: A Systematic Review and Meta-analysis

Abstract

Diverting loop ileostomy (DLI) with colonic lavage has been proposed as an alternative to total abdominal colectomy (TAC) for fulminant Clostridium difficile infection (CDI). Controversy exists regarding the mortality benefit and outcomes of this surgical approach. We conducted a MEDLINE database search for articles between 1999 and 2019 pertaining to DLI for the surgical treatment of CDI. Five articles met the inclusion criteria. Four studies were retrospective and one was a prospective matched cohort study. 3683 patients were included in the 5 studies; 733 patients (20%) underwent DLI, while 2950 patients (80%) underwent TAC. The only shared outcome measure across all 5 studies was mortality. The overall mortality rate for the entire cohort undergoing both procedures was 30.3%. There was no statistically significant difference in pooled mortality between DLI and TAC (OR: .73; 95% CI, .45-1.2; P = .22). Reporting of other postoperative outcomes was variable. Fulminant CDI remains a life-threatening condition with high mortality. Loop ileostomy may be a viable surgical alternative to total colectomy with similar mortality; however, further work is needed to determine specific patient characteristics that warrant routine use of DLI.

High Serum Levels of Toxin A Correlate with Disease Severity in Patients with Clostridioides difficile Infection

“…The Gram-positive anaerobic bacterium Clostridioides difficile (CD) is a leading cause of nosocomial diarrhea worldwide, accounting for 15% of all such infections and resulting in significant morbidity, mortality, and prolonged hospital stay [ 1 , 2 , 3 ]. The clinical manifestations of CD infection (CDI) range from mild diarrhea to pseudomembranous colitis and toxic megacolon that is relatively uncommon but is associated with high morbidity and mortality [ 4 ]. A relevant issue during CDI is its high rate of recurrences (rCDI).…”