Postoperative pseudomembranous colitis after abdominal surgery: pathogenesis, diagnosis and current management

Pseudomembranous colitis, a severe complication of antibiotic use, is primarily caused by Clostridioides difficile infection (CDI), and poses a significant risk to postoperative patients, especially following abdominal surgery. We reviewed the pathogenesis, diagnostic challenges, prevention strategies, and management approaches for postoperative pseudomembranous colitis in both adult and pediatric populations. Antibiotic-induced disruption of the normal gut microbiota enables colonization and toxin production by C. difficile, with additional influences from surgical factors and host susceptibility. Diagnostic methods include stool tests (Glutamate dehydrogenase (GDH) antigen, toxin Enzyme immunoassay (EIA), Nucleic acid amplification test (NAAT)) and endoscopy, with specific considerations needed for pediatric patients due to high colonization rates in infants. Prevention focuses on antibiotic stewardship, with treatment options ranging from oral vancomycin and fidaxomicin for mild-to-moderate cases to surgical intervention for fulminant disease. Fecal microbiota transplantation has emerged as an effective treatment for recurrent and severe cases. While most patients recover with appropriate treatment, CDI significantly prolongs hospitalization and increases readmission rates. Early recognition, prompt diagnosis, and tailored management are essential to improve outcomes in this potentially life-threatening complication of surgery.

Pseudomembranous colitis; Clostridioides difficile; Postoperative infection; Antibiotic stewardship; Fecal microbiota transplantation

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