This protocol addresses fulminant Clostridioides difficile infection with leukocytosis greater than 15 × 10³/µL, accompanied by shock, sepsis, multiorgan failure, ileus, or megacolon — the most severe and life-threatening presentation of CDI.
Initial medical management of fulminant C. difficile colitis — including discontinuation of the inciting antibiotics, resuscitation for shock, oral vancomycin, IV metronidazole, and rectal vancomycin enemas — has failed to achieve the required targets: resolution of shock and a decreasing white blood cell count.
This protocol defines the next step when that failure threshold is crossed.
DOI: 10.1186/s13017-021-00362-3
Severe complicated or fulminant C. difficile infection is defined by leukocytosis greater than 15 × 10³/µL with associated shock, sepsis, multiorgan failure, ileus, or megacolon.
The operative procedure of choice is a subtotal abdominal colectomy with end ileostomy, typically via an open approach given the severity of illness in this patient population.
There is some evidence to suggest that loop ileostomy with antegrade antibiotic lavage can serve as a colon-sparing alternative to subtotal colectomy.
This technique involves a laparoscopic creation of a loop ileostomy followed by antegrade lavage of polyethylene glycol solution via the ileostomy followed by antibiotic lavage with vancomycin and IV antibiotics.