Fulminant C diff colitis---call the surgeons!

A retrospective study and editorial commentary in Archives of Surgery reviewed the topic of FCDC and cited risk factors for increased mortality. At the risk of cramping our comanagement style, I thought this point was interesting:

Survival rates are higher in patients who were cared for by surgical vs nonsurgical departments, possibly because of more frequent and earlier operations.

The editorial made these points:

Increased patient age, immunosuppression, hypoalbuminemia, significant leukocytosis, and increased serum lactate levels have all been shown, in this or other reviews, to correlate with the need for operation and with ultimate treatment outcome. Nevertheless, there is no absolute threshold in any of these categories and no finding on CT scan, short of pneumoperitoneum, that predicts the need for operation with certainty for an individual patient.

So when does the patient with C diff colitis have a surgical abdomen? When a good surgeon says they have one!