Patient selection: Clostridium difficile colitis (diarrhea, positive toxin assay, and pancolitis on imaging studies)
Indications for operative management - one or more of the following:
(1) peritonitis
(2) worsening abdominal distention with severe pain
(3) sepsis (septic shock)
(4) new onset of respiratory failure with need for mechanical ventilation
(5) new or increasing requirement for vasopressors
(6) changes in mental status
(7) clinical deterioration not explained by another cause
(8) nonimproving or worsening leukocytosis (> 20,000 per µL) or leukopenia (< 3,000 per µL) or bandemia (> 10%) despite appropriate antibiotic therapy for > 96 hours
