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Colon-sparing surgery for Clostridium difficile.

There has been recent evidence from a large multi-center study sponsored by the Eastern Association for the Surgery of Trauma that colon-sparing surgery reduces mortality for patients with severe Clostridium difficile associated disease (CDAD) when compared to total colectomy. Amoebic colitis shares many pathologic and clinical features to CDAD, such as worsening diarrhoea, patchy colonic ulceration and necrosis, toxic megacolon, pseudomembranous colitis, perforation, and death. However, published research regarding amoebic colitis is sparse. Surgical management of amoebic colitis may be required in Low Income Countries, or at the geographical interface between more developed and less developed nations, such as at the United States-Mexican border. The authors propose that until further data are available, evidence from CDAD might be applied to the management of amoebic colitis, and surgeons may wish to consider colon-sparing surgery in this context. Large scale prospective studies are warranted, in order to determine whether this practice is associated with similar improvements in outcomes recently observed with CDAD.


TYPE OF ARTICLE
Current opinion LEVEL OF EVIDENCE: Not applicable.