Clostridium difficile infection surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Patients with signs/symptoms of fulminant colitits should be evaluated by surgery for possible urgent surgery for bowel perforation, impending perforation, severe ileus with megacolon, or refractory septicemia.

Surgery

Indications for Surgery

Indications for surgery include:

• Peritoneal signs
• Persistent bacteremia
• Progressive disease
• CT showing pericolonic inflammation with increasing bowel wall edema.

Colectomy

In those patients that develop systemic symptoms of CDC, colectomy may improve the outcome if performed before the need for vasopressors. The usual intervention is a subtotal colectomy with ileostomy.

Recurrence

The evolution of protocols for patients with recurrent C. difficile diarrhea also present a challenge: there is no known proper length of time or universally accepted alternative drugs with which one should be treated. However, re-treatment with metronidazole or vancomycin at the previous dose for 10 to 14 days is generally successful. The addition of rifampin to vancomycin also has been effective. Prophylaxis with competing, nonpathogenic organisms such as Lactobacillus spp. or Saccharomyces boulardii has been found to be helpful in preventing relapse in small numbers of patients (see, for example, Florastor, or Lactinex). It is thought that these organisms, also known as probiotics, help to restore the natural flora in the gut and make patients more resistant to colonization by C. difficile.