Loop Ileostomy a Viable Alternative for Clostridium difficile Colitis?

To the Editor Juo et al¹ found that no significant difference was observed between loop ileostomy (LI) and total abdominal colectomy (TAC) for treating fulminant Clostridium difficile colitis (FCDC) in their retrospective cohort study. The overall in-hospital mortality rate for patients undergoing surgery for FCDC was 30.1%, with no significant difference between LI and TAC (26.0% vs 31.1%; P = .28). The findings would be beneficial for patients with FCDC because LI could be less invasive and maintain physiologic functions of colon compared with TAC. However, we are concerned about the higher rates of operative wound disruption (5.6% vs 2.3%; P = .04) and surgical site infection (SSI) (8.9% vs 3.6%; P = .01) among patients receiving LI compared with TAC, which is inconsistent with the prior study² that showed the lower SSI rate for LI compared with TAC (2.1% vs 10.5%; P < .07).