Combined Management of Severe Pseudomembranous Colitis: A Clinical Case Utilizing the ATLAS Scale

Aim. To present clinical experience with combined management of severe pseudomembranous colitis using the ATLAS scale for risk stratification and therapeutic optimization. For patients scoring 4-6 points on the ATLAS scale, a diverting loop ileostomy is created with intraoperative catheter placement through the efferent limb into the colonic lumen. In the postoperative period, sequential antegrade colonic lavage is administered via the catheter according to the following protocol: vancomycin 125-250 mg, metronidazole 500-1000 mg, and fidaxomicin 200-220 mg in 500 mL of normal saline, followed by rebamipide 100-120 mg in 500 mL of normal saline - administered twice daily with a 6-hour interval for 10 days. Conclusion. The reported case demonstrates the effectiveness of this combined strategy for managing severe Clostridioides difficile-associated pseudomembranous colitis refractory to standard medical treatment.