Abstract
While surgical intervention is recommended for fulminant Clostridium difficile infection (CDI), the indications, timing, and technique of surgical intervention remain controversial because of the high postoperative mortality. We herein report a fatal case of fulminant CDI complicated with a toxic megacolon that required a colectomy. A 69-year-old male suffered from CDI complicated with septic shock and high intra-abdominal pressure, and he soon developed multiple organ failure. He first underwent a colostomy in order to reduce his intra-abdominal pressure. After the colostomy, his lactate concentration value was temporary improved to below 5 mmol/l. However, the level soon increased to above 5 mmol/l, and he therefore underwent a second-look operation, and received a right-side colectomy and a massive small bowel resection. After the second-look surgery, he suffered from severe sepsis which was probably caused by the residual CDI and/or a bacterial translocation, and/or other health-care associated infections. The patient was also complicated with a short-bowel syndrome-related hepatic failure. On postoperative day 45, he developed multiple organ failure and died. To ensure that surgical benefit can be derived from intervention for fulminant CDI, physicians therefore have to timely perform subtotal colectomies when deemed appropriate.
