Outcome After Colectomy for Clostridium Difficile Colitis

Abstract

Patients with fulminant C. difficile colitis often present with an unexplained abdominal illness with a marked leukocytosis that rapidly progresses to shock and peritonitis. Although frequently developed during a hospitalization and often after a surgical procedure, it may develop outside of a hospital setting. Diarrhea may be absent and stool cytology may be negative for C. difficile toxin. Perforation and infarction are frequently found at surgery. In those patients who survive, a prolonged hospitalization is common. Mortality from fulminant C. difficile colitis remains high despite surgical intervention.

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

“…Th e vague term " clinical deterioration " is frequently mentioned in already critically ill patients in whom medical therapy has failed. Th ese strategies rely on surgery as a salvage therapy, which may account for the poor outcomes associated with subtotal colectomy in complicated CDI, and mortality rates that range from 35 % to 80 % ( 38,39,41,42,65,72 ). It has become evident that surgery is of benefi t to patients at the advanced extreme of CDI, and early surgical consultation has been associated with improved survival.…”

Is Diarrhea Enough to Assess the Severity of Clostridium difficile–Associated Disease?

“…2 We agree that although diarrhea is the hallmark symptom of CDAD, a comprehensive CDAD severity grading system must also incorporate many of the symptoms that Jaber et al 1 mention. In fact, only 31 (84%) of 37 patients in our study had diarrhea that was clinically important enough to be documented in their medical charts within 48 hours of CDAD diagnosis, despite the fact that all of them had unformed stool samples collected for C. difficile toxin testing.…”

“…2 " 9 In some patients, life-threatening systemic toxicity can develop despite appropriate and timely medical therapy. 2,3 Hemodynamic data, as well as respiratory and urinary output data, have been used for severity assessment among patients with C. difficile colitis. Dallal et al 3 classified patients who had systolic blood pressure greater than 100 mm Hg, heart rate greater than 90 beats per minute, moderate tachypnea, and decreasing volume of urinary output that responds to fluid resuscitation as patients with moderate disease; patients who required vasopressors, had a heart rate greater than 120 beats per minute, required mechanical intubation, and had severe oliguria were classified as patients with fulminant disease.…”

“…3 Because of space limitations, we were unable to list all of the CTCAE in our article. 2 In this letter, we provide a Table that details how the CTCAE are used in our grading system. Many of the signs and symptoms mentioned by Jaber et al 1 are part of the CTCAE for colitis.…”

Ileostomía en asa derivativa y lavado colónico intraoperatorio como alternativa de tratamiento en un caso de colitis grave por Clostridium difficile

“…Esta intervención, en este contexto, se asocia a una mortalidad de 50-80%, una morbilidad importante y una baja tasa de reconstitución de tránsito 7,11 .…”