With the increased use of prophylactic and broad-spectrum antibiotics, 
pseudomembranous colitis has emerged as a significant clinical problem. 
Management with specific anti-Clostridium difficile therapy (vancomycin or 
metronidazole) has reduced mortality to less than 2%. Nevertheless, the disease 
may progress to a fulminant toxic colitis or colonic perforation. Additionally, 
another subset of patients will present with a dramatic clinical picture, 
suggesting acute peritonitis, eventuating in unnecessary laparotomy. This report 
reviews both the medical and surgical literature during the past 15 years of 
patients treated for pseudomembranous colitis. Analysis of this clinical data 
has provided us with the opportunity to both define the role of surgery in this 
disorder and illustrate the necessity for a combined medical and surgical 
cooperative approach in the early management of this iatrogenic disease.