Minimally Invasive Approaches to Clostridium Difficile Colitis

Abstract

Clostridium difficile infection (CDI) has been increasing in incidence over the past three decades. It is now recognized as a major healthcare-associated complication and is the leading nosocomial pathogen. Disease severity ranges from mild diarrhea to severe sepsis with multiple organ dysfunction. Early recognition, diagnosis, and treatment are necessary to prevent disease progression. Despite best effort, some cases progress in severity, and the development of severe, complicated disease (sometimes known as fulminant colitis or the development of toxic megacolon) is associated with a high rate of mortality. Surgical treatment for severe, complicated disease was defined in the 1990s to be subtotal abdominal colectomy and end ileostomy. Although mortality is improved by colectomy in patients that are critically ill compared to those treated with medical therapy alone, outcomes are still poor. There may be opportunity to improve outcomes by more aggressive nonsurgical interventions, earlier surgical intervention, and alternative surgical techniques when managing severe CDI. This chapter highlights some of the minimally invasive surgical and nonsurgical approaches to treat patients with severe, complicated CDI.