A 45-yrs old woman undergoes an uneventful laparoscopic

Discussion in 'MRCS Forum' started by Lona., Dec 13, 2007.

  1. Lona.

    Lona. Guest

    A 45-yrs old woman undergoes an uneventful laparoscopic cholecystectomy for which she receives one dose of cephalosporin. One week later, she returns to the emergency room with fever, nausea and copious diarrhea and is subsequently diagnosed with pseudomembranous colitis. With respect to this disease, which one of the following statements is correct?
    a- Surgical intervention is frequently required
    b- After appropriate antibiotic therapy, the relapse rate is less than 5%
    c- Tissue culture assay for Clostridium difficile toxin B is neither sensitive nor specific; therefore diagnosis should be based on clinical findings
    d- If surgery is performed, a left hemicolectomy is usually adequate to treat pseudomembranous colitis
    e- Indications for surgical treatment include intractable disease, failure of medical therapy, toxic megacolon, and colonic perforation
  2. Lona.

    Lona. Guest

    Answer: e. (Lipsett, Surgery 116:491-496, 1994) Pseudomembranous colitis is a common nosocomial infection most often caused by Clostridium difficile toxins A and B. Antibiotic use allows overgrowth of C. difficile, leading to abdominal pain, fever, diarrhea, and increased WBCs. Diagnosis is confirmed by isolation of C. difficile toxin B via tissue culture assay. Sensitivity and specificity are quite high (greater than 90%), but the test may require 24 to 48 h to complete. The vast majority of patients will respond to vancomycin or Metronidazole, although 20 to 30% of patients may elapse. Because response to antibiotic therapy is high, surgical intervention is infrequently required (<1%). Indications for surgery include intractable or fulminant disease, failure of medical therapy, colonic perforation, and toxic megacolon. Pseudomembranous colitis often involves the entire colon, despite normal-appearing serosa. Therefore, the procedure of choice is a subtotal colectomy with ileostomy. Overall mortality of 35 to 40% is described, with <20% mortality for those patients undergoing subtotal colectomy.

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