ii. Confounders and their measurement: Fortunately, FCDC is managed on an emergency basis only; thus the surgeon on-call (based on the on-call schedule) is the one who will care for the patient and the patient does not choose their surgeon, nor is the surgeon choosing their patient. This eliminates any referral bias, that is, surgeon assignment can be considered random and there is no bias for different surgeons to be treating different types of patients. All general and colorectal surgeons are equally qualified to make the clinical decision to operate for FCDC (inclusion criteria for the study) and to perform the both proposed operations, TAC and loop ileostomy. However, individual surgeon bias may exist towards one procedure. This will be examined by a short qualitative questionnaire requesting the rationale for the choice of operation. Due to the infrequency of the operation for FCDC and the need to recruit multiple participating surgeons, each surgeon may only contribute 1-3 patients. Variability in individual and institution clinical practice will be accounted for by clustering by surgeon and institution in the analysis. Institution and surgeon variability may introduce may reflect differences in technical skill, hospital infrastructure, degree of adoption of early surgical consultation for FCDC, and operating room availability. Due to the severity of FCDC requiring surgery and the critically ill nature that patients reach prior to surgical consultation, the patient population entered into the trial will be relatively homogenous. This remarkable homogeneity within the patient population presenting for surgical management of FCDC was observed in our hospitals (2,5) and in Neal et al.'s study (4). Nonetheless, we will anticipate and account for confounding patient factors in the analysis including older age, immunosuppression, elevated pre-op white blood cell count, lactate, intubation and vasopressors (2,3,5). Earlier time to surgery is associated with improved survival and may also be a confounder as surgeons may be more inclined to offer loop ileostomy and lavage earlier than they would offer TAC given its minimally invasive nature. Similarly due to the new intervention's less invasive nature, older patients with co-morbidities may be more inclined to consent to surgery than they would be if offered TAC; introducing confounding by indication.