Fulminant Clostridium difficile colitis (FCDC) is a major complication of C. difficile colitis that has not responded to non-invasive interventions, and is ultimately treated with laparotomy, total abdominal colectomy (TAC), and end-ileostomy. Diverting loop ileostomy and colonic lavage, however, represents another surgical option in the management of FCDC, with prior studies suggesting a lower associated mortality when compared to TAC. In this retrospective cohort study, 2408 patients who underwent surgery for C. difficile colitis (2011-2015) were followed up to compare outcomes of diverting loop ileostomy versus abdominal colectomy in the management of FCDC. Overall, 613 patients (20.28%) underwent diverting loop ileostomy without TAC. Over the course of the study period, the annual proportion of patients undergoing diversion increased from 11.6% in 2011 to 25.30% in 2015. Rates of in-hospital mortality did not significantly differ between the two groups (p=0.28). There was also no difference observed in the length of stay when comparing the two groups (p=0.99). Of note, however, there were higher rates of operative wound disruption (p=0.04) and surgical site infection (p=0.01) in patients that underwent diverting loop ileostomy, as compared to TAC. The results show no significant difference in mortality rate between diverting loop ileostomy and TAC in the management of FCDC on retrospective analysis, and as such, the former may represent a reasonable surgical alternative to TAC. The increased risks of surgical site infection and wound disruption with diverting loop ileostomy, however, should be considered as well as potential selection bias.

Click to read the study in JAMA Surgery

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