Diarrhoea and pseudomembranous colitis after gastrointestinal operations. A prospective study

Area of Science:

• Gastroenterology
• Infectious Diseases
• Colorectal Surgery

Background:

• Postoperative diarrhea is a common complication following gastrointestinal surgery.
• Antibiotic exposure is a known risk factor for gastrointestinal disturbances.
• Pseudomembranous colitis is a severe form of antibiotic-associated colitis.

Purpose of the Study:

• To investigate the incidence and characteristics of postoperative diarrhea in patients undergoing gastrointestinal operations.
• To identify the role of antibiotics in the development of postoperative diarrhea.
• To assess the diagnostic accuracy of sigmoidoscopy and rectal biopsy for pseudomembranous colitis.

Main Methods:

• Prospective study of 241 patients who underwent gastrointestinal operations.
• Monitoring for occurrence of postoperative diarrhea.
• Assaying stool samples for neutralizable fecal toxin and isolating toxigenic Clostridium difficile strains.
• Evaluating diagnostic yield of sigmoidoscopy and rectal biopsy.

Main Results:

• Postoperative diarrhea occurred in 24% of patients, significantly higher with antibiotic exposure.
• 9% of patients had high titers of neutralizable fecal toxin.
• Toxigenic Clostridium difficile strains were isolated from all patients with detectable toxin.
• Sigmoidoscopy and rectal biopsy frequently missed the diagnosis of pseudomembranous colitis.

Conclusions:

• Antibiotic-associated diarrhea is a significant concern after gastrointestinal surgery.
• The presence of neutralizable fecal toxin is a key indicator of pseudomembranous colitis.
• Current endoscopic diagnostic methods may underestimate the prevalence of pseudomembranous colitis.