title: Colonic decompression and direct intraluminal medical therapy for Clostridium difficile-associated megacolon using a tube placed endoscopically in the proximal colon.
abstract: OBJECTIVE
  Urgent colectomy for severe Clostridium difficile infection can be associated with increased morbidity and mortality. We aimed to use endoscopic methods for treatment.
  
  
  METHODS
  We describe a technique of placing an intracolonic tube facilitating decompression and direct delivery of vancomycin to the proximal colon along with enemas on a regular and frequent basis that may not be possible with vancomycin enemas alone.
  
  
  RESULTS
  Successful resolution of the C. difficile infection and avoidance of surgery.
  
  
  CONCLUSIONS
  While further long-term evaluation is required, our initial results have shown it to be effective in treating select patients with recalcitrant Clostridium difficile-associated megacolon.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Tacoma, Washington, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Causey
authors.forename: A
authors.initials: A
authors.lastname: Walker
authors.forename: M
authors.initials: M
authors.lastname: Cummings
authors.forename: E K
authors.initials: EK
authors.lastname: Johnson
authors.forename: J A
authors.initials: JA
authors.lastname: Maykel
authors.forename: S
authors.initials: S
authors.lastname: Steele
mesh_terms: D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile; D003113:Colonoscopy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D004733:Enema; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008531:Megacolon / Q000209:etiology / Q000601:surgery*; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Clostridium difficile; colonic decompression; colonic lavage; megacolon