Acute abdomen and Clostridium difficile colitis: Still a lethal combination

Background: With the steadily prevalent appropriate and inappropriate use o f antimicrobial agents, Clostridium difficile colitis has continued to be n oticed as a common problem in hospitalized patients. The aim of this commun ication is to highlight a subset of C. difficile colitis patients who prese nted with an acute abdomen. Methods: This is a retrospective study of 10 pa tients who underwent laparotomy for an 'acute abdomen' with an intraoperati ve or postoperative diagnosis of C. difficile colitis. Results: All patient s received antibiotics (mean 9.5 days) for other illnesses. The mean APACHE II score was 18.8 (range 8-25) and the mortality rate was 80%. Two patient s had colostomies created. One patient underwent a subtotal colectomy, and another underwent a Hartmann procedure; the rest had a nontherapeutic proce dure, Conclusion: We conclude that C. difficile colitis presenting as an 'a cute abdomen' still represents a lethal entity. Patients who present with a n 'acute abdomen', with a history of recent or current antibiotic intake, a nd without findings which mandate an exploration should have C. difficile c olitis urgently excluded. Timely diagnosis of C. difficile colitis through bedside sigmoidoscopy or a CT scan could spare the critically ill patient a n unneccessary and risky operation. Furthermore, if laparotomy is subsequen tly needed then having a preoperative diagnosis of C. difficile colitis wil l allow appropriate surgical therapy to be implemented. Copyright (C) 2000 S. Karger AG. Basel.