The surgical procedure of choice is resection of the entire colon within the peritoneum, from the cecum to the peritoneal reflection (subtotal colectomy, or total abdominal colectomy).
Indications for surgical resection:
(1) clinical progression despite optimum medical therapy
(2) progression in the CT scan despite optimum medical therapy
(3) signs and symptoms of peritonitis
(4) toxic megacolon
(5) development of organ failure
The external appearance of the colon along its serosal surface may be deceptively benign, even when there are extensive inflammatory pseudomembranes.
Risk factors for death after surgery:
(1) advanced age
(2) shock with need for vasopressors prior to surgery (indicating surgery when the patient had fulminant disease)
(3) failure to perform a subtotal colectomy
