Kent KC, Rubin MS, WrobleskiL, et al (Harvard Medical School, Boston)
The Impact of Clostridium difficile on a surgical service; A prospective study of 374 patients.
Am Surg 227: 296-301, 1998
Clostridium difficle colitis (CDC) is a common nosocomial infection that causes discomfort and sometimes severe illness in patients admitted with unrelated medical or surgical conditions.
Factors associated with CDC were:
2) Treatment with any antibiotic
3) Nasogastric tube suction
4) Advanced age
5) Previous antibiotic treatment especially cefoxitin
Abdominal pain and fever occurred frequently in patients with CDC.
Patients undergoing intestinal surgery frequently experience CDC. In the above series the course of CDC was not severe. The infection responded well to oral metronidazole and vancomycin.
Althie CG, Guizar CB, Alcantara A V, et al (Univ of Mexico)
Twenty five years of experience in the surgical treatment of perforation of the Ileum caused by Salmonella typhi at the General Hospital of Mexico City, Mexico.
Surgery 123 : 632-636, 1998.
This report of 25 years experience with surgical management of intestinal perforation caused by S.typhi strongly supports the use of directed intestinal resection.
In this procedure, 10cm is resected on each side of the distal and proximal perforation.
Even in patients with a single perforation, primary closure should be avoided because of intestinal wall alterations in the area surrounding the perforation.