Recurrent Clostridium difficile Infection after Diverting Loop Ileostomy and Colonic Lavage: An Unreported Complication of the Novel Surgical Therapy

摘要

Clostridium difficile infection (CDI) is the leading cause of infectious diarrhea in the developed world with steadily increasing incidence and disease severity. Its treatment places a large burden on hospitals worldwide, costing the American healthcare system alone nearly 5 billion dollars annually. Initial treatment of CDI depends on severity of infection and typically begins with antibiotic therapy. Early surgical consultation is recommended for those who have severe disease or who are not responding to medical management. The gold standard surgical treatment of severe, complicated CDI is total abdominal colectomy and end ileostomy, although Neal et al. published an alternative technique of diverting loop ileostomy and colonic lavage (IL) with postoperative antegrade van-comycin enemas in 2011. Treatment with this less-invasive surgery resulted in preservation of the colon in 93 per cent of patients in addition to reduction of overall mortality when compared with patients treated with total abdominal colectomy. Although these outcomes were promising, little follow-up data have been published on the technique or its complications to validate its continued use in the treatment of CDI. After a patient who had undergone IL unexpectedly died from recurrent fulminant CDI days after successful ileostomy reversal, we chose to review our institution's experience with IL. The purpose of the study was to determine the rate of CDI recurrence in this surgical population and publish on this important and concerning complication.