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Related Experiment Videos

Pseudomembranous colitis: a surgical disease?

P A Lipsett1, D K Samantaray, M L Tam

  • 1Department of Surgery and Infectious Disease, Johns Hopkins Medical Institutions, Baltimore, MD.

Surgery
|September 1, 1994
PubMed
Summary
This summary is machine-generated.

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Surgical intervention for toxic pseudomembranous colitis (PMC) is rarely needed but critical for organ failure or peritonitis. Subtotal colectomy offers better outcomes than left hemicolectomy for this severe Clostridium difficile infection.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Infectious Diseases

Background:

  • Pseudomembranous colitis (PMC) is a growing nosocomial infection caused by Clostridium difficile.
  • Oral vancomycin is the standard treatment, but severe toxic forms may necessitate surgery.
  • Surgical indications and optimal procedures for toxic PMC remain unclear.

Purpose of the Study:

  • To review surgical interventions for toxic PMC.
  • To clarify indications for surgery.
  • To evaluate surgical outcomes and mortality rates.

Main Methods:

  • Retrospective review of adult patients undergoing surgery for PMC over six years.
  • Analysis of C. difficile toxin assay data (3300 positive results out of 37,000 assays).

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Main Results:

  • Thirteen patients (0.39%) required surgery for toxic PMC.
  • Indications included systemic toxicity, peritonitis, or worsening CT scans.
  • Mortality was 38% overall; 100% for left hemicolectomy vs. 14% for subtotal colectomy.

Conclusions:

  • Surgery for toxic PMC is rare but indicated for organ failure, peritonitis, or worsening imaging.
  • Subtotal colectomy is the recommended procedure, regardless of colon appearance.
  • Appropriate surgical management can yield acceptable outcomes for these critically ill patients.