• Andrea D Olivas, Konstantin Umanskiy, Brian Zuckerbraun, and John C Alverdy.
• Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
• Surg Infect (Larchmt). 2010 Jun 1;11(3):299-305.

BackgroundClostridium difficile is the most common cause of nosocomial diarrhea in adults. Over the last decade, there has been a substantial increase in the disease-associated morbidity and mortality rate from this infection accompanied by identification of new hypervirulent strains. Fulminant colitis, a severe and complicated form of the disease that frequently necessitates surgical intervention, occurs in 3-8% of patients infected with C. difficile. The postoperative mortality rate for fulminant colitis continues to be dire, ranging from 34-57%.MethodsReview of the literature to offer insight into the dilemma associated with the surgical management of fulminant C. difficile colitis and provide alternatives to total abdominal colectomy for treatment.ResultsSeveral recent studies have elucidated factors that contribute to the unacceptably high postoperative mortality rate: Surgical intervention too late in the course of the disease, lack of clearly defined guidelines for patient selection, and difficulty in predicting the clinical course of the disease. Perforation, need for vasopressor support, and end-organ damage all affect the postoperative mortality rate negatively.ConclusionA high clinical suspicion and careful patient selection for colectomy is imperative to improve postoperative survival. An alternative surgical strategy for fulminant C. difficile colitis is laparoscopic creation of an ileostomy with total colonic washout.

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