Purpose of Review <p>To highlight the role for surgical management in severe complicated Clostridiodes difficile infection.</p> Recent Findings <p>Surgical consultation is warranted in all patients with severe complicated CDI. Near total abdominal colectomy or diverting loop ileostomy with colonic lavage are surgical procedures for the management of CDI.</p> Summary <p>Early surgical consultation improves outcomes for patients with severe complicated CDI. Surgical management of patients prior to hemodynamic collapse is essential to improve mortality. The challenge in the management of this disease is the only dogmatic indication for surgical management is peritonitis, hemodynamic collapse, or “toxic megacolon.” All of which may be too late for patient salvage and leads to a high mortality rate. Considering earlier surgical management with recognition of a worsening clinical picture prior to decompensation is necessary to improve survival. This is facilitated by repeated examination and setting clear parameters that would lead to operative management (worsening exam, increased pain, initiation of pressors, etc.).</p>