Diverting Loop Ileostomy and Colonic Lavage

作者：Matthew D. Neal, John C. Alverdy, Daniel E. Hall, Richard L. Simmons, Brian Scott Zuckerbraun · 发表于：Annals of Surgery · 年份：2011 · DOI：10.1097/sla.0b013e31822ade48 · 被引用次数：341 · 研究领域：Clostridium difficile and Clostridium perfringens research、Diverticular Disease and Complications、Surgical site infection prevention

In Brief Objective: To determine whether a minimally invasive, colon-preserving approach could serve as an alternative to total colectomy in the treatment of severe, complicated Clostridium difficile–associated disease (CDAD). Background: C. difficile is a significant cause of morbidity and mortality worldwide. Most cases will respond to antibiotic therapy, but 3% to 10% of patients progress to a severe, complicated, or “fulminant” state of life-threatening systemic toxicity. Although the advocated surgical treatment of total abdominal colectomy with end ileostomy improves survival in severe, complicated CDAD, outcomes remain poor with associated mortality rates ranging from 35% to 80%. Methods: All patients who were diagnosed with severe, complicated (“fulminant”) CDAD and were treated at the University of Pittsburgh Medical Center or VA Pittsburgh Healthcare System between June 2009 and January 2011 were treated with this novel approach. The surgical approach involved creation of a loop ileostomy, intraoperative colonic lavage with warmed polyethylene glycol 3350/electrolyte solution via the ileostomy and postoperative antegrade instillation of vancomycin flushes via the ileostomy. The primary end point for the study was resolution of CDAD. The matching number of patients treated with colectomy for CDAD preceding the initiation of this current treatment strategy was analyzed for historical comparison. Results: Forty-two patients were treated during this time period. There w...