Early Colectomy Saves Lives in Toxic Megacolon due to Clostridium difficile Infection

Nasim Ahmed, MD, FACS; Yen-Hong Kuo, PhD


South Med J. 2020;113(7):345-349. 

In This Article


One hundred sixty-three patients met the inclusion criteria of the study. Approximately 85% of patients underwent total abdominal colectomy, whereas 15% of patients underwent partial colectomy. The majority of patients were admitted directly from home. Approximately 18% of patients were admitted from nursing facilities. Almost 100% of patients were classified as ≥3 on the ASA-class. The overall 30-day mortality was 39.16%.

Of 163 patients, 101 (62%) underwent colectomy after presenting with septic shock. Only 62 (38%) patients underwent colectomy before the onset of septic shock. On univariate analysis, some significant differences were found between the early and late groups regarding patients' race (P = 0.04), history of CKD (P = 0.006), CKD with dialysis (P = 0.038), ASA-class (P = 0.001), and vent-support (P < 0.001) (Table 1). As such, propensity score matching was calculated and pair-matched analyses were performed between the two groups. No significant differences were found between the groups on pair-matched analyses on baseline characteristics and comorbidities (Table 2).

There was a significant decrease in 30-day mortality in patients who underwent colectomy before the onset of septic shock versus the late group (13 [21%] vs 28 [45.25], P = 0.009; Table 3). There also was a significant decrease in total hospital length of stay in the early group when compared with the late group (median [95% CI] 20 [14–34] vs 25 [21–37], P = 0.011). When comparing the discharged disposition to skilled nursing facility of the two groups, there was no significant difference identified between the groups (34.7% vs 48%, P = 0.52).

No significant differences were found between the two groups regarding postoperative complications. After colectomy, <10% of patients developed septic shock in the early group and 38.2% of patients continued to have septic shock in the late group (Table 4).