Surgical treatment of Clostridium colitides.

ABSTRACT

INTRODUCTION: Infection with Clostridium difficile (CDI) is the most frequent cause of nosocomial diarrhoeas. Most cases are successfully treated by antibiotic therapy, but nearly 10% may progress to the fulminative form of this condition. The objective of the work is retrospective evaluation of the results of surgical treatment in patients with the fulminative form of Clostridium colitis with revealing of risk factors leading to serious post-operative morbidity and mortality. PATIENTS AND METHODOLOGY: Retrospective evaluation of the results of surgical treatment in patients with the fulminative form of Clostridium colitis between 2008 and 4/2012. RESULTS: Between 2008 and 4/2012 Clostridium toxins were positively detected in 1,088 patients in total, 21 of whom underwent operations due to the fulminative form of Clostridium colitis. The operations included 4 total colectomies with terminal ileostomy, 15 subtotal colectomies with terminal ileostomy, 1 caecostomy and 1 axial ileostomy. The 30-day mortality was 23.8%, and morbidity reached 66.6%. High leukocytosis is a statistically significant predictor of post-operative mortality and morbidity (p = 0.008). CONCLUSION: Early indication for a colectomy operation with terminal ileostomy in patients with the fulminative form of Clostridium colitis leads to lower morbidity and mortality.