Surgery for fulminant Clostridium difficile infection

Fulminant Clostridium difficile infection is an important clinical entity for surgeons given the increasing incidence and severity of the disease worldwide. Indications for surgery have not been standardized, but a worsening clinical picture from serial examination, laboratory evaluation, or overall clinical status appears to warrant surgical intervention. Total abdominal colectomy with end ileostomy confers a modest survival advantage but historical mortality rates range from 35% to 80% in small series. Diverting loop ileostomy has recently emerged as a possible alternative with decreased mortality rates and the advantage of preserving the colon.