Toxic megacolon
From IDWiki
Background
- Acute colonic distension that can lead to perforation and death
Etiology
- Inflammatory bowel disease
- Ulcerative colitis is most common
- Crohn disease, rarely
- Gastrointestinal infection
- Congenital
Clinical Manifestations
- Abdominal pain
- Signs of sepsis
- Fever
- Hypotension
- Shock
- Signs of IBD (usually ulcerative colitis)
- May be first presentation of IBD
Investigations
- Imaging:
- Abdominal X-ray will show colon dilated > 6cm
Diagnosis
- Radiographic evidence of colonic distension
- Plus at least three of:
- Fever > 38ºC
- Heart rate > 120bpm
- WBC > 10.5
- Anemia
- Plus at least one of:
- Volume depletion
- Altered sensorium
- Electrolyte abnormalities
- Hypotension
Management
- Conservative
- Bowel rest, NG tube
- If IBD: steroids
- If infectious: antibiotics
- If conservative treatment fails, proceed to surgery for subtotal colectomy and end-ileostomy