title: Outcomes following colectomy for Clostridium difficile colitis.
abstract: BACKGROUND
  Clostridium difficile associated diarrhoea has become an important health problem in UK hospitals but surgical intervention is rarely required. There is little evidence regarding best practice for patients requiring surgical intervention. The aim of this multicentre study was to review our experience in patients requiring surgery for C. difficile colitis.
  
  
  METHODS
  Patients who underwent surgery for C. difficile colitis in 5 hospitals in Southeast England over a 7-year period (1 teaching hospital and 4 district general hospitals) were identified from histopathology databases. Data were collected regarding the presentation, indication for surgery and post-operative outcomes.
  
  
  RESULTS
  15 patients (9 males; mean age=71 years (range 35-84 years)) underwent surgery. 46% of patients (n=7) contracted C. difficile during their hospital admission for other medical reasons and 73% of patients were initially admitted under other medical specialties. Diagnosis was only made preoperatively in 8 patients (53%). Indications for surgery were peritonitis and systemic toxicity (n=12), failure of medical management (n=2) and unresolving large bowel dilatation (n=1). 12 patients underwent total colectomy and the rest underwent segmental resection. All patients were admitted to the intensive care unit post operatively with a mean stay of 6 days. 2 patients needed a second look laparotomy. Mortality rate was 67% (n=10), with all but 1 patient dying within the 30-day mortality period. The mean length of hospital stay of survivors was 30 days (range 17-72).
  
  
  CONCLUSIONS
  Surgical intervention for C. difficile colitis remains uncommon. Total colectomy and end ileostomy is the procedure of choice. The outlook for patients requiring surgery remains poor.
authors.affiliation: Department of General Surgery, Guy's and St Thomas' NHS Trust, St Thomas' Hospital, London, UK. shirley.chan@talk21.com
authors.forename: Shirley
authors.initials: S
authors.lastname: Chan
authors.forename: Mark
authors.initials: M
authors.lastname: Kelly
authors.forename: Sophie
authors.initials: S
authors.lastname: Helme
authors.forename: James
authors.initials: J
authors.lastname: Gossage
authors.forename: Bijan
authors.initials: B
authors.lastname: Modarai
authors.forename: Matthew
authors.initials: M
authors.lastname: Forshaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D003082:Colectomy; D003092:Colitis / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome