A 45-year-old woman undergoes an uneventful laparoscopic cholecystectomy for which she receives 1 dose of cephalosporin. One week later, she returns to the emergency room with fever, nausea, and copious diarrhea and is suspected of having pseudomembranous colitis. She is afebrile and has no peritoneal signs on abdominal examination. She has a mild leukocytosis with a left shift. Which of the following is the appropriate initial management strategy?
Treatment of C difficile colitis is metronidazole for firstline therapy and oral vancomycin as a second-tier agent. Recurrence appears in up to 20% of patients. Indications for surgical treatment are intractable disease, failure of medical therapy, toxic megacolon, and colonic perforation; surgical therapy consists of subtotal colectomy with end ileostomy. The diagnosis can be made by either detection of the characteristic appearance of pseudomembranes on endoscopy or detection of either toxin A or toxin B in the stool. Anti-diarrheal agents are contraindicated in suspected C difficile colitis as they may prolong the infection.
Administration of an antidiarrheal agent
Exploratory laparotomy with left hemi-colectomy and colostomy
Exploratory laparotomy with subtotal abdominal colectomy and ileostomy
Administration of oral metronidazole
Preoperative assessment and monitoring in anaesthesia