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Toxic megacolon

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Title: Toxic megacolon  
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Subject: Ileo-anal pouch, Ogilvie syndrome, Megacolon, Intestinal pseudoobstruction, Ulcerative colitis
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Toxic megacolon

Toxic megacolon
Micrograph of pseudomembranous colitis, a cause of toxic megacolon. H&E stain.
Classification and external resources
ICD-10 K59.3
ICD-9-CM 556.9
DiseasesDB 27702
MedlinePlus 000248
eMedicine med/1418 radio/702
MeSH D008532

Toxic megacolon (megacolon toxicum) is an acute form of colonic distension.[1] It is characterized by a very dilated colon (megacolon), accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock.

Toxic megacolon is usually a complication of inflammatory bowel disease, such as ulcerative colitis and, more rarely, Crohn's disease, and of some infections of the colon, including Clostridium difficile infections, which have led to pseudomembranous colitis. Other forms of megacolon exist and can be congenital (present since birth, such as Hirschsprung's disease). Also, it can be caused by Entamoeba histolytica and Shigella.

Contents

  • Signs and symptoms 1
  • Treatment 2
  • Prognosis 3
  • Complications 4
  • Footnotes 5
  • References 6
  • Further reading 7

Signs and symptoms

There may be signs of septic shock. A physical examination reveals abdominal tenderness and possible loss of bowel sounds. An abdominal radiography shows colonic dilation. White blood cell count is usually elevated. Severe sepsis may present with hypothermia or leukopenia.

Treatment

Toxic megacolon in a patient with ulcerative colitis: The patient subsequently underwent a colectomy.

The objective of treatment is to decompress the bowel and to prevent swallowed air from further distending the bowel. If decompression is not achieved or the patient does not improve within 24 hours, a colectomy (surgical removal of all or part of the colon) is indicated. When surgery is required the recommended procedure is a subtotal colectomy with end ileostomy.[2] Fluid and electrolyte replacement help to prevent dehydration and shock. Use of corticosteroids may be indicated to suppress the inflammatory reaction in the colon if megacolon has resulted from active inflammatory bowel disease. Antibiotics may be given to prevent sepsis.[3]

Prognosis

If the condition does not improve, the risk of death is significant. In case of poor response to conservative therapy, a colectomy is usually required. This may involve all or part of the colon being removed, with the resulting option of anastomosis or ileostomy. Ileostomy carries far less risk of infection and postoperative complications because the risk of deterioration of sutures within the intestinal tract (as a result of anastomosis) is not present. The risk of death and shock has been reported to be lower in children, but most children required colectomy in one case-control study.[4]

Complications

A pathological specimen showing toxic megacolon
  • Perforation of the colon[5]
  • Sepsis
  • Shock


Emergency action may be required if severe abdominal pain develops, particularly if it is accompanied by fever, rapid heart rate, tenderness when the abdomen is pressed, bloody diarrhea, frequent diarrhea, or painful bowel movements.

Colonoscopy is contraindicated, as it may rupture the dilated colon resulting in peritonitis and septic shock.

Footnotes

  1. ^ "Toxic megacolon" at Dorland's Medical Dictionary
  2. ^ Seltman, AK (December 2012). Colitis"Clostridium difficile"Surgical Management of . Clinics in Colon and Rectal Surgery 25 (4): 204–9.  
  3. ^ Autenrieth, DM; Baumgart, DC (August 2011). "Toxic megacolon". Inflammatory Bowel Diseases 18: 584–91.  
  4. ^ Benchimol, EI; Turner, D; Mann, EH; Thomas, KE; et al. (June 2008). "Toxic megacolon in children with inflammatory bowel disease: Clinical and radiographic characteristics".  
  5. ^ Panos, MZ; Wood, MJ; Asquith, P (December 1993). "Toxic megacolon: The knee-elbow position relieves bowel distension". Gut 34 (12): 1726–7.  

References


Further reading

  • Ausch, C; Madoff, RD; Gnant, M; Rosen, HR; Garcia-Aguilar, J; Hölbling, N; Herbst, F; Buxhofer, V; Holzer, B; Rothenberger, DA; Schiessel, R (March 2006). "Aetiology and surgical management of toxic megacolon". Colorectal Disease 8 (3): 195–201.  
  • Toxic Megacolon at eMedicine


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