PSEUDOMEMBRANOUS COLITIS - A SURGICAL DISEASE

Background. Pseudomembranous colitis (PMC) is an increasingly common n osocomial infection caused by Clostridium difficile and its toxins. Th e disease is usually treated with oral vancomycin. The toxic form of P MC, which requires surgical intervention, is uncommon and often carrie s a higher mortality rate. The indications and recommended surgical pr ocedure and the results of current surgical treatment remain unclear. Methods. All charts of adults undergoing surgical intervention for PMC during the last 6 years were retrospectively reviewed. During the las t 6 years an estimated 37,000 C. difficile toxin assays have been perf ormed with 3300 positive results. Results. Thirteen adults (0.39%) und erwent surgical intervention for PMC. Surgical intervention was perfor med for systemic toxic effects in all patients, with physical signs of peritonitis in six patients and worsening computed tomographic scans with ongoing illness despite appropriate medical therapy in five. The overall mortality rate in the series was 38%; in those undergoing left hemicolectomy (n = 4) the mortality rate was 100% versus a mortality rate of 14% for those undergoing subtotal colectomy (n = 9). Conclusio ns. Despite the effectiveness of oral vancomycin therapy, surgical the rapy is occasionally although rarely indicated for the treatment of to xic PMC. Surgical intervention should be considered when the patient h as signs of organ failure, a worsening CT scan, or signs of peritoniti s. At laparotomy the external appearance of the colon is often decepti vely normal and should not influence the surgical procedure of choice, subtotal colectomy. These severely ill patients can be treated with a n acceptable morbidity and mortality rate.