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Related Experiment Videos

Outcome after colectomy for Clostridium difficile colitis.

Walter E Longo1, John E Mazuski, Katherine S Virgo

  • 1Department of Surgery, St. Louis University School of Medicine, St. Louis, Missouri, USA. walter.longo@yale.edu

Diseases of the Colon and Rectum
|November 13, 2004
PubMed
Summary
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Fulminant Clostridium difficile colitis requiring colectomy has a high mortality rate (48%) and often presents with severe symptoms like shock and peritonitis, even without diarrhea. Early surgical intervention is crucial for survival in these critical cases.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Surgical Gastroenterology

Background:

  • Clostridium difficile colitis (C. difficile colitis) is common, but fulminant cases requiring colectomy are rarely reported in large series.
  • Understanding risk factors and outcomes is crucial for managing severe C. difficile colitis.

Purpose of the Study:

  • Identify risk factors for fulminant C. difficile colitis.
  • Characterize the clinical presentation of patients needing colectomy.
  • Determine the outcomes for patients undergoing colectomy due to fulminant C. difficile colitis.

Main Methods:

  • A population-based study analyzed data from 159 Department of Veterans Affairs hospitals between 1997 and 2001.
  • Data were compiled from national computerized datasets and local medical records.

Related Experiment Videos

  • Statistical analysis used Pearson chi-squared and Fisher's exact tests (P < 0.05).

    • Main Results:

    • Sixty-seven patients (mean age 69, 99% male) underwent colectomy for C. difficile colitis.
    • 54% developed colitis during hospitalization (87% post-surgery), 46% developed it at home.
    • 45% presented in shock, 64% with acute surgical abdomen; 48% overall mortality.
    • Perforation/infarction found in 58% of surgeries; prolonged hospitalization common for survivors.

    Conclusions:

    • Fulminant C. difficile colitis often presents with unexplained abdominal illness, leukocytosis, shock, and peritonitis.
    • It can develop in-hospital, post-surgery, or at home, sometimes without diarrhea or with negative stool assays.
    • Mortality remains high despite surgical intervention, with survivors facing prolonged hospital stays.