Clostridium difficile and the Surgeon

• Published in: The American surgeon Vol. 76; no. 3; pp. 235 - 244
• Main Authors: STANLEY, J. Daniel, BURNS, R. Phillip
• Format: Journal Article
• Language: English
• Published: Atlanta, GA Southeastern Surgical Congress 01.03.2010; SAGE PUBLICATIONS, INC
• Subjects: Anti-Infective Agents - administration & dosage; Apoptosis; Biological and medical sciences; Clostridium difficile - classification; Clostridium difficile - pathogenicity; Colectomy; Diarrhea; Enterocolitis, Pseudomembranous - diagnosis; Enterocolitis, Pseudomembranous - drug therapy; Enterocolitis, Pseudomembranous - epidemiology; Enterocolitis, Pseudomembranous - surgery; Feces - microbiology; Fever; General aspects; Health participants; Humans; Ileostomy; Illnesses; Medical sciences; Metronidazole - administration & dosage; Mortality; Pathogenesis; Postoperative Complications - microbiology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Recurrence; Risk Factors; Surgical Procedures, Operative; Toxins; Virulence; Medicine; Treatment; Surgery; Clostridiaceae; Clostridium difficile; Clostridiales; Diarrhea; Bacteria; Digestive diseases; Intestinal disease; Surgeon
• ISSN: 0003-1348; 1555-9823

The most important toxins responsible for symptoms are toxin A and toxin B,13 which are large proteins with similar structure and 49 per cent amino acid identity.14 It is now known that both toxins A and B are able to produce endotoxic effects related to the symptom of diarrhea and the breakdown of the mucosal barrier and cytotoxic effects, which result in cell death and systemic toxicity.\n11, 12, 59 There are insufficient data at this time to make a recommendation of segmental colectomy over total colectomy with ileostomy even if the colitis appears to be segmental. The surgeon must be aware that C. difficile small bowel enteritis has been reported in patients after total colectomy and the diagnosis must be considered if the patient experiences high ileostomy output postoperatively.60 Ileostomy closure with ileorectal anastomosis may be performed after complete recovery, which will typically require longer than 3 months because of the severity of illness responsible for the surgical intervention in CDI cases.