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Case Reports in Surgery
Volume 2016 (2016), Article ID 5909248, 4 pages
http://dx.doi.org/10.1155/2016/5909248
Case Report

Blowhole Colostomy for Clostridium difficile-Associated Toxic Megacolon

1Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
2Department of General Surgery, Heilig-Hartziekenhuis, Lier, Belgium

Received 24 August 2016; Accepted 30 November 2016

Academic Editor: Paola De Nardi

Copyright © 2016 Jeroen Kerstens et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present the case of a 58-year-old man who underwent urgent blowhole colostomy for toxic megacolon (TM) secondary to Clostridium difficile infection (CDI). This infection occurred under antibiotic coverage with amoxicillin-clavulanic acid, four days after laparoscopic sigmoidectomy in our hospital. Although prospective clinical research regarding the surgical management of TM is lacking, decompressive procedures like blowhole colostomy are reported to carry a high risk of postoperative morbidity and mortality and are widely regarded as obsolete. Subtotal or total colectomy with end ileostomy is currently considered the procedure of choice. After presenting our case, we discuss the literature available on the subject to argue that the scarce evidence on the optimal surgical treatment for TM is primarily based on TM associated with inflammatory bowel diseases (IBD) and that there might be a rationale for considering minimally invasive procedures like blowhole colostomy for CDI-associated TM.