A Fatal Case of Clostridium difficile Enterocolitis following Diverting Loop Ileostomy Reversal

Abstract

Background: Clostridium difficile infection (CDI) is one of the most common hospital-acquired infections (HAI). Fulminant colitis is a severe form of the disease and is considered a surgical emergency. A total colectomy is the current standard of care for patients with this diagnosis. A new emerging procedure, diverting loop ileostomy with colonic lavage, has shown to have less morbidity, allowing preservation of the native colon. Methods: We present a patient who developed sepsis secondary to fulminant CDI. He received treatment with diverting loop ileostomy and colonic lavage in addition to antimicrobial agents. Seven months later, disease free, he underwent ileostomy reversal but then developed recurrent toxic megacolon and enteritis secondary to CDI. Conclusion: Even though diverting loop ileostomy with colonic lavage in the setting of a complicated infection seems to have initial benefits, additional studies are needed to address long-term morbidity/mortality.