International Journal of Surgery

Department of General Surgery, Guy's and St Thomas' NHS Trust, St Thomas' Hospital, London, UK.
International Journal of Surgery (London, England) (Impact Factor: 1.53). 12/2008; 7(1):78-81. DOI: 10.1016/j.ijsu.2008.11.002
Source: PubMed


Clostridium difficile associated diarrhoea has become an important health problem in UK hospitals but surgical intervention is rarely required. There is little evidence regarding best practice for patients requiring surgical intervention. The aim of this multicentre study was to review our experience in patients requiring surgery for C. difficile colitis.
Patients who underwent surgery for C. difficile colitis in 5 hospitals in Southeast England over a 7-year period (1 teaching hospital and 4 district general hospitals) were identified from histopathology databases. Data were collected regarding the presentation, indication for surgery and post-operative outcomes.
15 patients (9 males; mean age=71 years (range 35-84 years)) underwent surgery. 46% of patients (n=7) contracted C. difficile during their hospital admission for other medical reasons and 73% of patients were initially admitted under other medical specialties. Diagnosis was only made preoperatively in 8 patients (53%). Indications for surgery were peritonitis and systemic toxicity (n=12), failure of medical management (n=2) and unresolving large bowel dilatation (n=1). 12 patients underwent total colectomy and the rest underwent segmental resection. All patients were admitted to the intensive care unit post operatively with a mean stay of 6 days. 2 patients needed a second look laparotomy. Mortality rate was 67% (n=10), with all but 1 patient dying within the 30-day mortality period. The mean length of hospital stay of survivors was 30 days (range 17-72).
Surgical intervention for C. difficile colitis remains uncommon. Total colectomy and end ileostomy is the procedure of choice. The outlook for patients requiring surgery remains poor.

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Available from: Shirley Chan, Aug 25, 2015
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    • "Reference Year Design Special cohort Centre(s) Study interval Total no. of operated patients NOS stars Al-Abed et al. 7 2010 R Southend, UK 2007–2009 20 6 Ali et al. 16 2008 R Connecticut, USA 1995–2006 36 9 Ananthakrishan et al. 17 2011 R IBD only Nationwide inpatient sample, USA 1998, 2004, 2007 574 2 Byrn et al. 5 2008 R New York, USA 1994–2005 73 9 Chan et al. 18 2009 R 5 hospitals, UK 2000–2007 15 7 Dallal et al. 19 2002 R Pittsburgh, USA 1989–2000 44 6 Dudukgian et al. 20 2010 R Los Angeles, USA 1999–2006 14 9 Gash et al. 21 2010 R Bristol, UK 2006–2007 17 7 "
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