Colonic lavage in treatment of refractory Clostridium difficile infection: an adaptation of the Pittsburgh protocol

Journal of Surgical Case Reports
Maura MorganTimothy J Farrell

Abstract

Clostridium difficile infection (CDI) is a common nosocomial sequela in patients treated with antibiotics. Surgical intervention is indicated in fulminant cases. However, the mortality associated with total colectomy and end ileostomy is high. Previous reports have indicated that surgical intervention for severe complicated CDI with formation of a loop ileostomy leading to the diversion of fecal stream followed by colonic lavage can be beneficial in treating severe CDI. This procedure is known as the Pittsburgh protocol and has been reported to decrease the mortality and the need for a total colectomy in patients with severe complicated CDI. In this case, we present a 75-year-old female with refractory CDI. In her treatment, we adapted the Pittsburgh protocol and utilized a 20-French MIC gastrostomy tube to recreate the ileocecal valve and control the colonic lavage without retrograde flow.

References

Aug 27, 2013·World Journal of Gastrointestinal Surgery·Andrew J Klobuka, Alexey Markelov
Dec 3, 2013·Clinics in Colon and Rectal Surgery·Ann K Seltman
Aug 2, 2017·BMJ Open·Greig McCreeryUNKNOWN ERASE C. difficile (Early Rescue from Acute SEvere Clostridium difficile) Trials Group
Feb 21, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·L Clifford McDonaldMark H Wilcox

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lavage

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