Clostridium difficile Enteritis after Colectomy

Clostridium difficile infection of the colon is, unfortunately, a relatively common occurrence that typically follows treatment with antibiotics; however, C. difficile infection of the small bowel is a much more rare phenomenon with only 19 cases reported to date. We present three cases of isolated C. difficile enteritis after colectomy. Although all three patients were identified early and successfully treated with medical management without the need for surgical intervention, previous authors have suggested a much higher morbidity and mortality rate with this infection. This article reviews the current available literature on C. difficile enteritis to highlight this potentially serious condition in postoperative colectomy patients who present with low-grade fevers, abdominal or pelvic pain, and increased ileostomy output.

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P210 Clostridium difficile infection in pre-existing inflammatory bowel disease: Management and outcomes

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.339 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S244-S245

Author(s):

I CAMPBELL ◽

E Brownson ◽

E Robertson

Keyword(s):

Inflammatory Bowel Disease ◽

Clostridium Difficile ◽

Length Of Stay ◽

Clostridium Difficile Infection ◽

Bowel Disease ◽

Surgical Intervention ◽

Morbidity And Mortality ◽

Health Board ◽

Inflammatory Bowel ◽

One Year

Abstract Background Inflammatory bowel disease (IBD) is a recognised risk factor for clostridium difficile infection (CDI), and CDI in an IBD patient is associated with higher morbidity and mortality. It is thought that factors including alterations in the gut microbiome, mucosal disruption and immunosuppression provide a synergistic environment for CDI to complicate an IBD flare. Despite this, there is conflicting evidence available on management. Our aim was to examine a series of recent cases to assess our own practice and subsequent outcomes. Methods A retrospective analysis was carried out of hospitalised cases of CDI in IBD patients in Greater Glasgow and Clyde from 2017 to 2018. Patients were identified via the CDI database held by the microbiology department; those with co-existing IBD were extrapolated. Data collected included demographics, IBD subtype and presence of other CDI risk factors. Severity of symptoms was assessed using Truelove and Witts Criteria. Initial management and changes following the diagnosis of CDI were noted. Outcomes were measured by the length of stay, survival to discharge, and requirement for surgical intervention. One year outcomes were assessed by recording mortality, treatment escalation and re-admission to hospital. Results 29 patients in total were identified (61% female, 39% male). Twenty-one had a diagnosis of ulcerative colitis, 7 Crohn’s disease, and 1 IBD unclassified. Twenty-four were on immunosuppressive therapy at the time of CDI, 11 were on dual or triple immunosuppression. This was continued during admission in all but three cases. Once the diagnosis of CDI was established, metronidazole was given in 16 cases and vancomycin in 13. Steroid treatment varied - 13 received oral steroids, 5 IV steroids and 11 no steroids. There was no clear correlation between steroid management and outcome. Assessment with the Travis criteria on day 3 indicated a high chance of colectomy in 12 patients, however only one required surgical intervention. No patients received a faecal transplant. The median length of stay was 15 days (range 3–169). One patient did not survive to discharge. In those surviving to discharge, a further 6 had died at one year, bringing the one-year mortality to 24%. Three had CDI as a contributory factor listed on the death certificate. 31% of surviving patients had their IBD treatment escalated in the year following admission, 17% were treated for CDI relapse, and 28% had readmission to hospital. Conclusion Managing CDI in patients with co-existing IBD is challenging. This case series highlights the lack of consensus on how this should be approached, even within a single health board. Morbidity and mortality are high. This suggests that a wider body of work is required to establish guidelines and provide better outcomes.

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Clostridium difficile infection of the small bowel—two case reports with a literature survey

International Journal of Colorectal Disease ◽

10.1007/s00384-010-1001-y ◽

2010 ◽

Vol 26 (2) ◽

pp. 245-251 ◽

Cited By ~ 15

Author(s):

Christoph Holmer ◽

Urte Zurbuchen ◽

Britta Siegmund ◽

Ute Reichelt ◽

Heinz J. Buhr ◽

...

Keyword(s):

Small Bowel ◽

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Case Reports ◽

Literature Survey

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Fatal Clostridium difficile infection of the small bowel after complex colorectal surgery

ANZ Journal of Surgery ◽

10.1046/j.1440-1622.2001.02083.x ◽

2001 ◽

Vol 71 (8) ◽

pp. 500-503 ◽

Cited By ~ 20

Author(s):

Joe J. Tjandra ◽

Alan Street ◽

Robert J. Thomas ◽

Robert Gibson ◽

Peter Eng ◽

...

Keyword(s):

Small Bowel ◽

Clostridium Difficile ◽

Colorectal Surgery ◽

Clostridium Difficile Infection

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199 Impact of Frailty on Complications in Patients with Thoracic and Thoracolumbar Spinal Trauma

Neurosurgery ◽

10.1093/neuros/nyx417.199 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 253-254

Author(s):

Remi Aria Kessler ◽

Taylor Elise Purvis ◽

Rafael De la Garza Ramos ◽

Ali Karim Ahmed ◽

C Rory Goodwin ◽

...

Keyword(s):

Mortality Rate ◽

Surgical Intervention ◽

Adult Spinal Deformity ◽

Frailty Index ◽

Neck Surgery ◽

Thoracolumbar Fracture ◽

Morbidity And Mortality ◽

Frailty Status ◽

Frail Patients ◽

The Impact

Abstract INTRODUCTION It is well-documented that geriatric patients are at risk for serious injuries after trauma due to pre-existing medical conditions, physical changes of aging, and medication effects. Frailty has been demonstrated to be a predictor of morbidity and mortality in inpatient head and neck surgery, and for surgical intervention for adult spinal deformity and degenerative spine disease. However, the impact of frailty on complications following traumatic thoracolumbar/thoracic fracture is unknown and has not been previously assessed in the literature, particularly in a nationwide setting. METHODS This was a retrospective study of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database for the years 2007 through 2012. Patients who underwent spinal decompression (+/− fusion) or an alternative intervention, defined as vertebroplasty or kyphoplasty (VP/KP) for thoracic or thoracolumbar fracture were identified. Frailty status was determined using a modified frailty index from the Canadian Study of Health and Aging Frailty Index, with frailty defined as a score = 0.27. 30-day morbidity and mortality were compared between frail and non-frail patients in each treatment group. RESULTS >A total of 303 patients were included in this study. Of these, 38% of patients had VP/KP and 62% underwent surgery. Within the VP/KP cohort, 26% were frail. The proportion of these patients who developed at least one complication was 3.3% versus 3.6% for non-frail patients (P = 1.0). The 30-day mortality for frail versus not frail patients in this cohort was 0% versus 2.4% (P = 1.0) Among the surgical group, 13% were frail. In contrast, the likelihood of complications was 33.3% among frail patients and 4.2% for non-frail patients (P = <0.001). Frail patients also had a 16.7% 30-day mortality rate as compared to 0.6% in the non-frail group (P = 0.001). CONCLUSION Frailty and traditional surgical intervention are correlated with a higher 30-day complication and mortality rate in patients with traumatic thoracic and thoracolumbar fracture.

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Blunt Isolated Small Bowel Perforation Intervention: Does a Delay in Management Matter?

Emergency Medicine International ◽

10.1155/2020/7478485 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Sung Yong Hong ◽

Se Hun Kim ◽

Ki Hoon Kim

Keyword(s):

Small Bowel ◽

Surgical Intervention ◽

Bowel Resection ◽

Bowel Perforation ◽

Morbidity And Mortality ◽

Small Bowel Perforation ◽

Time Intervals ◽

Bowel Surgery ◽

Number Of Patients ◽

Significant Difference

Purpose. Blunt small bowel injury is rare, and its timely diagnosis may be difficult. The effects of a delayed intervention on prognosis are unclear. We aimed to determine whether the time to surgical intervention affects outcomes in patients with blunt small bowel perforation. Methods. The study was performed between March 2010 and December 2018 in adults (age >18 years) who initially underwent computed tomography and small bowel surgery only and survived more than one day postoperatively. They were categorized into three groups based on injury-to-surgery time intervals: ≤8, 8–24, and >24 h; similarly, they were also categorized into two groups of ≤24 and >24 h. Results. Bowel resection, length of stay (LOS), intensive care unit (ICU) LOS, morbidity, and mortality were analyzed as outcomes in 52 patients. The number of patients in the three groups (≤8, 8–24, and >24 h) based on the time-to-surgery was 33, 13, and 6, respectively. On comparing the three groups, there were no significant differences in LOS (24 [18–35], 21 [10–40], and 28 [20–98] days, respectively; p=0.321), ICU LOS (2 [1–12], 4 [2–26], and 11 [7–14] days; respectively, p=0.153), mortality (3% (n = 1), 15% (n = 2), and 0%, respectively; p=0.291), and morbidity (46% (n = 15), 39% (n = 5), and 50% (n = 3), respectively; p=0.871). However, there was a significant difference between the groups in bowel resection (67% (n = 22), 31% (n = 4), and 83% (n = 5), respectively; p=0.037). Additionally, there was no significant difference in outcomes between the two groups (≤24 and >24 h) with small bowel perforation. Conclusions. Delay in surgical intervention following blunt abdominal trauma may not affect the outcomes of patients with small bowel injuries, such as LOS, ICU LOS, morbidity, and mortality, except bowel resection.

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Does Adjunctive Tigecycline Improve Outcomes in Severe-Complicated, Nonoperative Clostridium difficile Infection?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw264 ◽

2017 ◽

Vol 4 (1) ◽

Cited By ~ 11

Author(s):

Mary T. LaSalvia ◽

Westyn Branch-Elliman ◽

Graham M. Snyder ◽

Monica V. Mahoney ◽

Carolyn D. Alonso ◽

...

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Surgical Intervention ◽

Small Sample Size ◽

Severity Of Illness ◽

Small Sample ◽

High Rate ◽

Limited Power ◽

Severe Clostridium Difficile Infection ◽

To Receive

Abstract Severe Clostridium difficile infection is associated with a high rate of mortality; however, the optimal treatment for severe- complicated infection remains uncertain for patients who are not candidates for surgical intervention. Thus, we sought to evaluate the benefit of adjunctive tigecycline in this patient population using a retrospective cohort adjusted for propensity to receive tigecycline. We found that patients who received tigecycline had similar outcomes to those who did not, although the small sample size limited power to adjust for comorbidities and severity of illness.

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Management of Appendicitis

10.5772/intechopen.100338 ◽

2022 ◽

Author(s):

Vishal P. Bhabhor

Keyword(s):

Acute Appendicitis ◽

Acute Abdomen ◽

Medical Management ◽

Surgical Intervention ◽

Life Time ◽

Morbidity And Mortality ◽

Surgical Emergency ◽

First Choice ◽

Common Causes ◽

India And China

Appendicitis is one of the most common causes of acute abdomen with life time risk between 6 and 8% and it’s a most common non obstetric surgical emergency during pregnancy. Appendicitis is claimed to be unknown in the villages of India and China in paper by A. M. Spencer. The reason is simply due to the fact that diagnostic facilities do not exist and cases are not recognized. So diagnosing acute appendicitis accurately and efficiently can reduce morbidity and mortality from perforation and other complications. Surgical intervention is the first choice for appendicitis with medical management being reserved for special situations.

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