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Chirurgia (Bucur) 2020 Mar-Apr;115(2):227-235

The emergency surgery for colorectal cancer is associated with high rates of morbidity and mortality due to factors related to the characteristics of the patients but also the therapeutic attitude. This study aims to identify the surgical interventions associated with the postoperative complications, with the main causes of morbidity, with the reinterventions and with the postoperative deaths. We included in this retrospective study 431 patients hospitalized and operated in an emergency for complicated colorectal malignant tumors in the Surgery II Clinic of the Clinical Emergency County Hospital "Sf. Read More

Surg J (N Y) 2020 Jan 3;6(1):e37-e41. Epub 2020 Mar 3.

Department of Internal Medicine and Medical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.

Hepatic portal venous gas (HPVG), a rare radiological finding, is historically considered an ominous sign with 100% mortality rates. The dictum that HPVG warrants surgical intervention is challenged in the recent literature. This is because of the identification of various causes of HVPG other than bowel gangrene. Read More

Aliment Pharmacol Ther 2020 01;51(1):208-209

Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA.

J Gastrointest Surg 2020 Feb 25;24(2):484-491. Epub 2019 Nov 25.

Department of Surgery, University of California, Davis, Medical Center, 2335 Stockton Blvd., Sacramento, CA, 95817, USA.

Clostridium difficile infection remains a common nosocomial illness with a significant impact on health care delivery. As molecular phenotyping of this organism has changed our understanding of its transmission and virulence, so too have diagnostic methods and treatment strategies evolved in recent years. The burden of this infection falls predominantly on elderly patients with comorbidities who have recently received antibiotics. Read More

Gut 2020 01 14;69(1):83-91. Epub 2019 Oct 14.

Center for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong, China.

Objective: The underlying microbial basis, predictors of therapeutic outcome and active constituent(s) of faecal microbiota transplantation (FMT) mediating benefit remain unknown. An international panel of experts presented key elements that will shape forthcoming FMT research and practice.

Design: Systematic search was performed, FMT literature was critically appraised and a 1-day round-table discussion was conducted to derive expert consensus on key issues in FMT research. Read More

Surg Endosc 2019 Oct 10. Epub 2019 Oct 10.

Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA.

Background: Transanal total mesorectal excision (taTME) is a surgical approach for low rectal cancer with a learning curve estimated at 40-50 cases. The experience among taTME surgeons beyond their learning curve is limited.

Methods: A retrospective analysis of all taTME cases performed for rectal cancer at two tertiary care hospitals from 2014 to 2019 was conducted. Read More

Arab J Gastroenterol 2019 Sep 27;20(3):148-162. Epub 2019 Sep 27.

Department Gastroenterology-Hepatology, Meibergdreef, 1105 AZ Amsterdam, Netherlands.

JAMA Surg 2019 10;154(10):906

Department of Surgery, Amsterdam University Medical Centers, Academic Medical Center Location, Amsterdam, the Netherlands.

JAMA Surg 2019 10;154(10):899-906

Department of Surgery, University of California, Los Angeles, Los Angeles.

Importance: Diverting loop ileostomy and colonic lavage has generated much interest since it was first reported as a potential alternative to total abdominal colectomy for treating Clostridium difficile colitis in 2011. To our knowledge, few studies have validated the benefit reported in the initial description, and the association of this new approach with practice patterns has not been described.

Objective: To examine the national adoption pattern and outcomes of diverting loop ileostomy vs total abdominal colectomy as treatment for fulminant C difficile colitis. Read More

J Minim Invasive Gynecol 2020 May - Jun;27(4):883-891. Epub 2019 Jun 22.

Benign Gynecology Surgery Section, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio (Dr. Kho).

Study Objective: To validate the algorithm for selective bowel surgery based on preoperative imaging by comparing the perioperative outcomes of patients who undergo each type of bowel surgery for deep bowel disease, and secondarily to evaluate the incidence, factors, and subsequent outcomes when the actual procedure performed deviated from the preoperative surgical plan.

Design: Retrospective study comparing 3 surgical interventions in an intention-to-treat analysis.

Setting: Tertiary care hospital. Read More

J Trauma Acute Care Surg 2019 10;87(4):856-864

From the Division of Colon and Rectal Surgery (M.A.K., N.M., C.A.V., M.B.), Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research (S.R.B.), Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation (L.F.), McGill University, Montreal, Quebec, Canada; Sir Mortimer B. Davis Jewish General Hospital (Y.L.), Montreal, Quebec, Canada; Centre Hospitalier Universitaire de Sherbrooke (A.C.), Sherbrooke, Quebec, Canada.

Background: Clostridium difficile colitis is an increasingly important cause of morbidity and mortality. Fulminant C. difficile colitis (FCDC) is a severe form of the colitis driven by a significant systemic inflammatory response, and managed with a total abdominal colectomy. Read More

Am J Gastroenterol 2019 11;114(11):1708

Division of Gastroenterology, City of Hope National Medical Center, Duarte, California, USA.

Gastroenterology 2019 12 4;157(6):1492-1493. Epub 2019 May 4.

Division of Gastroenterology and Hepatology, Department of Medicine, Cook County Health and Hospital System, County, Chicago, Illinois.

Clin Transplant 2019 09 20;33(9):e13564. Epub 2019 Jun 20.

Department of Medicine, Division of Infectious Diseases, School of Medicine, Washington University, St. Louis, Missouri.

These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice address the prevention and management of Clostridium difficile infection in solid organ transplant (SOT) recipients. Clostridioides (formerly Clostridium) difficile infection (CDI) is among the most common hospital acquired infections. In SOT recipients, the incidence of CDI varies by type and number or organs transplanted. Read More

J Dig Dis 2019 Jun 10;20(6):301-307. Epub 2019 May 10.

Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.

Objective: Significant data support the efficacy and safety of fecal microbiota transplant (FMT) in recurrent Clostridium difficile infection (CDI). The objective of our study was to determine the success rate of FMT in patients diagnosed with severe and complicated CDI with impending colectomy in the intensive care setting.

Methods: This was a 2-center study of 9 patients who met the criteria for severe and complicated CDI and had an impending colectomy. Read More

SAGE Open Med Case Rep 2019 19;7:2050313X19838442. Epub 2019 Mar 19.

Clinic of Gastroenterology, Adana City Research and Education Hospital, University of Health Sciences, Adana, Turkey.

The infection-related disease varies from mild diarrhoea to pseudomembranouscolitis. Although infection is commonly considered to be a hospital-acquired infection, a significant number of cases are community acquired. Community-acquired infection can exhibit itself as ileus or toxic megacolon. Read More

World J Emerg Surg 2019;14. Epub 2019 Feb 28.

74Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy.

In the last three decades, infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. Read More

Pediatr Nephrol 2019 07 6;34(7):1269-1275. Epub 2019 Mar 6.

University Children's Medical Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background: During the last two decades, there has been a worldwide increase in frequency and severity of infections with Clostridium difficile (CDI). Solid organ transplant (SOT) recipients receiving immunosuppressing medications are especially at risk.

Methods: We collected data from immunocompromised pediatric patients, including kidney and liver transplant recipients, at our tertiary pediatric care center in Germany. Read More

Clin J Gastroenterol 2019 Aug 14;12(4):325-329. Epub 2019 Feb 14.

Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.

We report a case of community-acquired fulminant colitis caused by Clostridium difficile in Japan. A 46-year-old woman was diagnosed with severe infectious enterocolitis and was admitted at another hospital. The stool culture was positive for toxigenic C. Read More

Urol Oncol 2019 03 14;37(3):181.e7-181.e14. Epub 2018 Dec 14.

Department of Urology, Strong Memorial Hospital, University of Rochester, Medical Center, Rochester, NY.

Objective: To evaluate the role of antibiotic prophylaxis with oral ciprofloxacin prior to urinary catheter removal after radical prostatectomy in preventing urinary tract infection (UTI).

Materials And Methods: Patients undergoing radical prostatectomy were prospectively enrolled and randomized to either the antibiotic prophylaxis group (2 doses of oral ciprofloxacin prior to urinary catheter removal) or the control group (no antibiotics given prior to urinary catheter removal). Neither patients nor study providers were blinded to the group. Read More

J Trauma Acute Care Surg 2019 02;86(2):379-380

Division of Trauma Critical Care and Emergency Surgery (P.F.) Department of Surgery Virginia Commonwealth University Richmond, Virginia.

Dig Dis Sci 2019 02 25;64(2):382-390. Epub 2018 Oct 25.

Division of Gastroenterology, University of California San Diego, 9452 Medical Center Drive, ACTRI 1W501, La Jolla, CA, 92093, USA.

Background And Aims: Gastrointestinal pathogen panels (GPPs) are increasingly being used for evaluation of diarrhea. The impact of these tests on patients with inflammatory bowel diseases (IBD) is unknown. We performed a time-interrupted cohort study comparing GPPs and conventional stool evaluation in patients with IBD with diarrhea. Read More

Eur J Orthop Surg Traumatol 2019 Apr 22;29(3):667-674. Epub 2018 Oct 22.

Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.

Introduction: Revision total knee arthroplasty (TKA) procedures performed secondary to periprosthetic joint infection (PJI) are associated with significant morbidity and mortality. These poor outcomes may be further complicated by postoperative infection requiring antibiotics. However, antibiotic overuse may suppress patients' bacterial flora, leading to Clostridium difficile infection (CDI). Read More

BMC Anesthesiol 2018 09 27;18(1):133. Epub 2018 Sep 27.

University Department for Cardiac Surgery, Heart Center Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.

Background: Clostridium difficile (CD) is the most common pathogen causing nosocomial diarrhea. The clinical presentation ranges from mild diarrhea to severe complications, including pseudomembranous colitis, toxic megacolon, sepsis, and multi-organ failure. When the disease takes a fulminant course, death ensues rapidly in severe and complex cases. Read More

J Crohns Colitis 2019 Jan;13(1):27-38

Division of Gastroenterology, Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada.

Background And Aim: Clostridium difficile infection [CDI] is a significant concern in inflammatory bowel disease [IBD]. Risk factors and consequences associated with CDI in inflammatory bowel disease [IBD] patients are important to characterize. The aim of this research was to perform a systematic review and meta-analysis on risk factors and outcomes associated with CDI in IBD patients. Read More

Rev Esp Quimioter 2018 Oct 14;31(5):411-418. Epub 2018 Sep 14.

Emilio Bouza Santiago, Instituto de Investigación Sanitaria Gregorio Marañón, C/ Dr. Esquerdo, 46,28007 Madrid, Spain.

Objective: Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridium difficile infection (R-CDI). Despite its excellent efficacy, it is still not a routine procedure in most European centers. FMT has not been widely used in Spain to date. Read More

J Urol 2019 02;201(2):342-349

Purpose: The development of Clostridium difficile infection after cystectomy is associated with significant morbidity and mortality. We implemented a prospective screening program to identify asymptomatic carriers of C. difficile and assessed its impact on clinical C. Read More

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019 Jun 7;163(2):161-165. Epub 2018 Sep 7.

4 th Department of Internal Medicine - Haematology, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic.

Background: Ciprofloxacin prophylaxis used to be a standard precaution during autologous stem cell transplantation. Its benefit, with a high prevalence of fluoroqinolone resistance in the population, has recently been under scrutiny.

Objective: To evaluate the impact of cessation of ciprofloxacin prophylaxis during stem cell transplantation for multiple myeloma. Read More

Eur J Clin Microbiol Infect Dis 2018 Dec 3;37(12):2293-2299. Epub 2018 Sep 3.

Service de Biologie, Unité de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France.

Our aim was to study Clostridium difficile infection (CDI) in peripartum women in France and compare them to cases published in the literature. We characterize these infections regarding clinico-biological features and specific risk factors in order to raise awareness for obstetricians and midwifes. Eight antepartum and six post-partum CDI cases were retrospectively studied in 6 French centers during the period between 2008 and 2013. Read More

Adv Surg 2018 09 19;52(1):29-42. Epub 2018 Jun 19.

Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Tower 110, Baltimore, MD 21287, USA; Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Osler 603, Baltimore, MD 21287, USA.

Am J Transplant 2019 02 31;19(2):501-511. Epub 2018 Aug 31.

Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.

Fecal microbiota transplant (FMT) is recommended for Clostridium difficile infection (CDI) treatment; however, use in solid organ transplantation (SOT) patients has theoretical safety concerns. This multicenter, retrospective study evaluated FMT safety, effectiveness, and risk factors for failure in SOT patients. Primary cure and overall cure were defined as resolution of diarrhea or negative C difficile stool test after a single FMT or after subsequent FMT(s) ± anti-CDI antibiotics, respectively. Read More

Bone Marrow Transplant 2019 01 23;54(1):164-167. Epub 2018 Jul 23.

Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.

J Gastrointest Surg 2018 11 2;22(11):1968-1975. Epub 2018 Jul 2.

Division of Colorectal Surgery, Herbert Irving Pavilion, New York-Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA.

Background/purpose: While the use of oral antibiotic (OA) for bowel preparation is gaining popularity, it is unknown whether it increases the risk of Clostridium difficile infection (CDI). This study aimed to evaluate the impact of OA on the development of CDI after colectomy.

Methods: Patients who underwent colectomy from the ACS-NSQIP data (2015 and 2016) were included. Read More

Am Surg 2018 May;84(5):628-632

Department of Surgery, University of Arizona, Tucson, Arizona, USA.

Frailty has been noted as a powerful predictive preoperative tool for 30-day postoperative complications. We sought to evaluate the association between frailty and postoperative outcomes after colectomy for Clostridium difficile colitis. The National Surgical Quality and Improvement Program cross-institutional database was used for this study. Read More

Clin Infect Dis 2019 01;68(2):196-203

Merck & Co., Inc., Kenilworth, New Jersey.

Background: Clostridium difficile-associated diarrhea (CDAD) is common during hematopoietic stem-cell transplantation (HSCT) and is associated with increased morbidity and mortality. We evaluated fidaxomicin for prevention of CDAD in HSCT patients.

Methods: In this double-blind study, subjects undergoing HSCT with fluoroquinolone prophylaxis stratified by transplant type (autologous/allogeneic) were randomized to once-daily oral fidaxomicin (200 mg) or a matching placebo. Read More

Curr Gastroenterol Rep 2018 Jun 9;20(7):30. Epub 2018 Jun 9.

Department of Medicine, Division of Gastroenterology, University of Louisville, 550 S. Jackson St., Ambulatory Care Building 3nd Floor, Louisville, KY, 40202, USA.

Purpose Of Review: Fecal microbial transplantation (FMT) has become established as an effective therapeutic modality in the treatment of antibiotic-refractory recurrent Clostridium difficile colitis. A number of formulations and methods of delivery of FMT are currently available, each with distinct advantages. This review aims to review donor and patient selection for FMT as well as procedural aspects of FMT to help guide clinical practice. Read More

Aliment Pharmacol Ther 2018 07 30;48(2):152-159. Epub 2018 May 30.

Internal Medicine, Gastroenterology and Liver Unit, Gastroenterology and Oncology Area, Fondazione Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.

Background: Faecal microbiota transplantation (FMT) is a highly effective treatment against recurrent Clostridium difficile infection. Far less evidence exists on the efficacy of FMT in treating severe Clostridium difficile infection refractory to antibiotics.

Aim: To compare the efficacy of two FMT-based protocols associated with vancomycin in curing subjects with severe Clostridium difficile infection refractory to antibiotics. Read More

Tech Coloproctol 2018 03 5;22(3):191-199. Epub 2018 Mar 5.

Department of Surgery, Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, E19-125, Montreal, QC, H3G 1A4, Canada.

Background: Despite the implementation of enhanced recovery pathways (ERP), morbidity following colorectal surgery remains high. The aim of the present study was to estimate the impact of postoperative complications on excess hospital length of stay (LOS) in patients undergoing elective colorectal resection.

Methods: A retrospective study of patients undergoing elective colorectal surgery at a single institution from 2003 to 2010 was performed. Read More

Clin Microbiol Infect 2018 Jul 2;24(7):682-683. Epub 2018 Mar 2.

Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridium difficile (ESGCD).

Clin J Gastroenterol 2018 Aug 1;11(4):309-311. Epub 2018 Mar 1.

Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.

Liver transplant recipients are considered to be at high risk for Clostridium difficile infection, with an incidence of 2.7-8.0%, which is three times higher than that among other patients. Read More

Clin Orthop Relat Res 2018 03;476(3):453-462

Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.

Background: Patients with geriatric hip fractures may be at increased risk for postoperative Clostridium difficile colitis, which can cause severe morbidity and can influence hospital quality metrics. However, to our knowledge, no large database study has calculated the incidence of, factors associated with, and effect of C. difficile colitis on geriatric patients undergoing hip fracture surgery. Read More

Gastroenterology 2018 08 2;155(2):e11-e12. Epub 2018 Feb 2.

Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Alabama.

BMJ Case Rep 2018 Jan 26;2018. Epub 2018 Jan 26.

Imaging Department, Barts Health NHS Trust, London, UK.

While imaging appearances of pseudomembranous colitis are commonly recognised, radiological manifestations of -associated enteritis are poorly understood which, combined with the rarity of this infection involving small bowel, makes establishing the correct diagnosis challenging. Therefore, in order to encourage awareness of readers, we present a case of enteritis that manifested as abdominal sepsis complicating the postoperative period in a middle-aged woman with fistulating Crohn's disease and defunctioning ileostomy. Radiological appearances are described based on three consecutive CT studies performed 5 days prior to onset of symptoms, during the peak of enteritis, corresponding with the patient's clinical deterioration, and also 35 days later following treatment and resolution. Read More

Nat Rev Gastroenterol Hepatol 2018 02 4;15(2):68. Epub 2018 Jan 4.

J Arthroplasty 2018 05 2;33(5):1534-1538. Epub 2017 Dec 2.

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

Background: With the increased demand for primary total hip arthroplasty (THA) and corresponding rise in revision procedures, it is imperative to understand the factors contributing to the development of Clostridium difficile colitis. We aimed to provide a detailed analysis of: (1) the incidence of; (2) the demographics, lengths of stay, and total costs for; and (3) the risk factors and mortality associated with the development of C. difficile colitis after revision THA. Read More

J Trauma Acute Care Surg 2018 01;84(1):203-204

From the Academic Department of Military Surgery and Trauma (D.N.N., D.M.B.), Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom; NIHR Surgical Reconstruction and Microbiology Research Centre (D.N.N.), Queen Elizabeth Hospital, Birmingham, United Kingdom; and University of Birmingham (D.N.N., A.B.), Birmingham, UK.

Dis Colon Rectum 2017 Dec;60(12):1285-1290

1 Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania 2 Massachusetts Institute of Technology, Cambridge, Massachusetts 3 OpenBiome, Medford, Massachusetts 4 Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.

Background: A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with C difficile infection. However, risk scores specifically derived from surgical cohorts and designed for patients with C difficile infection are currently unavailable.

Objective: The aim of this study was to develop a risk of death score for patients with C difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy. Read More

Surg Pathol Clin 2017 Dec;10(4):863-885

Department of Pathology and Laboratory Medicine, Weill Cornell Medicine New York, Starr 1031 B, 1300 York Avenue, New York, NY 10065, USA. Electronic address:

This review describes a systematic approach to the interpretation of colonic biopsy specimens of patients with acute colitis. Five main histologic patterns are discussed: acute colitis, focal active colitis, pseudomembranous colitis, hemorrhagic colitis, and ischemic colitis. For each pattern, the most common etiologic associations and their differential diagnoses are presented. Read More

Colorectal Dis 2018 06;20(6):520-528

Department of General Surgery, Ipswich Hospital NHS Trust, Ipswich, UK.

Aim: The aim of this study was to determine whether or not preoperative oral antibiotic preparation (POAP) increases the rate of Clostridium difficile colitis (CDC) in patients undergoing colectomy.

Method: In 2015, data for colectomies had been collected prospectively and recorded in the targeted colectomy option of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). This was available for retrospective analysis. Read More

Clin Infect Dis 2018 02;66(5):645-650

Aix Marseille Université, CNRS, IRD, INSERM, AP-HM, URMITE, IHU Méditerranée Infection.

Background: Severe Clostridium difficile infections (CDIs) are associated with a high mortality rate despite medical and/or surgical treatment. Fecal microbiota transplantation (FMT) prevents recurrences, but its effect on survival has been shown only in patients with O27 ribotype CDI. Here, we investigated whether early FMT could improve survival in hospitalized CDI patients, particularly those with severe infection. Read More