MANAGEMENT OF PSEUDOMEMBRANOUS COLITIS

Controversy exists as to the appropriate management of fulminant C. di fficile-associated pseudomembranous colitis (PMC). We reviewed our mos t recent 5-year experience with 191 patients with PMC. Nine patients h ad an initial presentation of a surgical abdomen with clinical signs o f peritonitis, elevated white blood cell count, and eight had received antibiotics prior to presentation. Two patients were placed on no car diopulmonary resuscitation status at admission to the surgical intensi ve care unit; both died within 24 hours. The remaining seven patients had exploratory laparotomies. The four who had total abdominal colecto mies with ileostomies recovered promptly. Two of the other three had n o resection because there was edema of the colon, but no other gross p athological changes. The third had only a segmental colon resection. A ll three deteriorated postoperatively, and two were dead within 48 hou rs. The remaining patient was returned to the operating room 48 hours after the first procedure, and an abdominal colectomy and ileostomy wa s performed. She never recovered, however, and died 12 days later. We conclude that although most patients with PMC can be treated effective ly medically, total abdominal colectomy with ileostomy is indicated wh en signs of peritonitis occur, even if the only finding at laparotomy is edema of the colon.