Role of colonoscopic decompression in the treatment of toxic megacolon secondary to clostridium difficile colitis

Clostridium difficile infection (CDI) has recently re-emerged with increased incidence and severity. Risk factors of CDI include advanced age, hospitalization and prior antibiotic exposure. Toxic megacolon with paralytic ileus is a serious complication of Clostridium difficile colitis with mortality ranging from 25% to 40%. The diagnosis of toxic megacolon requires several clinical and radiological criteria. For severe cases, oral administration of metronidazole or vancomycin is the treatment of choice, in non-responding cases early surgical intervention is needed. Colonoscopic decompression may serve as an alternative therapeutic option.