Toxic megacolon

From IDWiki

Background

  • Acute colonic distension that can lead to perforation and death

Etiology

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