Journal List > J Korean Surg Soc > v.77(2) > 1010991

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Park, Kim, Seo, Kim, Kim, Cho, Jeon, Kim, Sim, Kim, and Kang: Pseudomembranous Colitis after Gastrointestinal Operation
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(2): 106-112.

Published online: 4 August 2009

DOI: https://doi.org/10.4174/jkss.2009.77.2.106

Pseudomembranous Colitis after Gastrointestinal Operation

Byung Soo Park, M.D., Jae Hun Kim, M.D., Hyung Il Seo, M.D., Hyun Sung Kim, M.D., Dae Hwan Kim, M.D., Hong Jae Cho, M.D., Tae Yong Jeon, M.D., Dong Heon Kim, M.D., Mun Sup Sim, M.D., Suk Kim, M.D.1, Hyung Sook Kang, Ph.D.2

Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea.

1Department of Radiology, Postgraduate School of Medicine, Pusan National University, Busan, Korea.

2College of Sport Sciences, Dong-A University, Busan, Korea.

Corresponding author (111160@pusan.ac.kr)

Received 19 March 2009       Accepted 13 May 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

The risk factors of pseudomembranous colitis (PMC) are well known. However, there have been no studies of PMC after gastrointestinal operation. The aim of this study was to evaluate the risk factors and to establish the guiding principles for PMC after gastrointestinal operation.

Methods

We performed a retrospective study of 39 PMC patients after gastrointestinal operation from January 2004 to December 2008. A control group of one hundred and seventeen matched to a PMC group by date of operation was chosen in a random fashion. Preoperative, operative, and postoperative factors of PMC were evaluated.

Results

The incidence of PMC after gastrointestinal operation was 0.63%. On univariate analysis, among preoperative factors, albumin, PT-INR and neutropenia were significant risk factors for PMC. There was no difference in the operative factors. Among postoperative factors, duration of cephalosporin, aminoglycoside, H2 blocker administration were significant risk factors for PMC after gastrointestinal operation. And transfusion, duration of NPO, length of stay in intensive care unit (ICU) and postoperative intraabddominal abscess, pneumonia were also significant risk factors. On multivariate analysis, the independent risk factors for PMC after gastrointestinal operation were duration of aminoglycoside administration, transfusion volume and length of stay in ICU. When period of study was divided by three months, incidence of PMC at a specific period was high. After limiting of prophylactic antibiotics, incidence of PMC fell to 0.36%.

Conclusion

To prevent PMC after gastrointestinal operation, we need sustained efforts to establish stricter guidelines about prophylactic antibiotics and transfusion, and to minimize length of stay in ICU.

Keywords: Pseudomembranous colitis, Gastrointestinal operation

Figures and Tables

Fig. 1
Overall incidence of pseudomembranous colitis. Arrow = prophylactic antibioticslimiting point.
jkss-77-106-g001
Table 1
Preoperative characteristics of pseudomembranous colitis group and control group
jkss-77-106-i001

*PMC = pseudomembranous colitis; †PT-INR = the international normalized ratio of prothrombin time; ‡ANC = absolute neutrophil count. Data are means±standard deviation.

Table 2
Operative characteristics of patients with pseudomembranous colitis and control group
jkss-77-106-i002

*PMC = pseudomembranous colitis; †Upper = stomach~treitz ligament; ‡Middle = treitz ligament~IC valve; §Lower = IC valve~rectum.

Table 3
Postoperative characteristics of patients with pseudomembranous colitis and control group
jkss-77-106-i003

*PMC = pseudomembranous colitis; †p.o. = per oral; ‡NPO = nothing by mouth; §ICU = intensive care unit. Data are means±standard deviation.

Table 4
Multivariate analysis of risk factors for pseudomembranous colitis after gastrointestinal operation
jkss-77-106-i004

*OR = odds ratio; †CI = confidence interval; ‡ICU = intensive care unit; §PT-INR = the international normalized ratio of prothrombin time; ∥NPO = nothing by mouth.

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