An Alternative to Colectomy for Severe C difficile Colitis

Albert B. Lowenfels, MD


October 03, 2011

Diverting Loop Ileostomy and Colonic Lavage: An Alternative to Total Abdominal Colectomy for the Treatment of Severe, Complicated Clostridium difficile Associated Disease

Neal MD, Alverdy JC, Hall DE, Simmons RL, Zuckerbraun BS
Ann Surg. 2011;254:423-429


Is there an alternative to total colectomy in patients with severe Clostridium difficile colitis? The authors performed ileal loop enterostomy plus colonic irrigation via the ileostomy with vancomycin in 42 patients and compared the results with 42 historical control patients with the same diagnosis. A significant decrease in mortality was found. Eight of 42 patients who were treated with ileostomy and lavage died compared with 21 of 42 patients who were treated with colectomy (P = .006). Overall morbidity was lower in the ileostomy group compared with the colectomy group (15 events and 26 events, respectively; P ≤ .05)


Most patients suffering from C difficile colitis can be treated with antibiotic therapy, but up to 10% of patients eventually require colectomy. The authors proposed a less aggressive surgical intervention that has a much lower mortality rate. This novel approach needs to be confirmed in a randomized trial rather than relying on historical controls. It is also possible that simply introducing an irrigation tube into the ileocecal region via the rectum may be effective.



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