Surgical aspects of fulminant Clostridium difficile Colitis

BACKGROUND: Clostridium difficile associated disease (CDAD) is responsible for the majority of nosocomial diarrhea, and fulminant C difficile colitis can have mortality upwards of 80%. Early identification and treatment of fulminant C difficile colitis is critical to patient care, but timing of surgical intervention remains difficult. This review summarizes the epidemiology, predictors of development, and management of fulminant C difficile colitis. METHODS: A literature search was conducted between January 1989 and May 2009 using the keywords "clostridium difficile colitis" or "fulminant clostridium difficile colitis" and "surgery." Articles not in English, those not involving human subjects, and case reports were excluded. CONCLUSION: Early diagnosis and treatment with subtotal colectomy and end ileostomy is critical in reducing the mortality associated with fulminant colitis. Patients who have a history of inflammatory bowel disease (IBD), recent surgery, prior treatment with intravenous immunoglobulin (IVIG), vasopressor requirements, leukocytosis, or increased lactate should have early surgical consultation and operative intervention. (C) 2010 Elsevier Inc. All rights reserved.