Toxic megacolon: Difference between revisions

Latest revision as of 10:53, 2 August 2020

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
- Hirschsprung disease

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

@@ Line 1: / Line 1: @@
-== Definition ==
+==Background==
-* Acute colonic distension that can lead to perforation and death
+*Acute colonic distension that can lead to perforation and death
-== Etiology ==
+===Etiology===
-* Inflammatory bowel disease
+*[[Inflammatory bowel disease]]
-** Ulcerative colitis is most common
+**[[Ulcerative colitis]] is most common
-** Crohn's disease, rarely
+**[[Crohn disease]], rarely
-* Gastrointestinal infection
+*Gastrointestinal infection
-** ''Clostridium difficile''
+**''[[Clostridioides difficile]]''
-** ''Entamoeba histolytica''
+**''[[Entamoeba histolytica]]''
-** Shigella
+**''[[Shigella]]''
-* Congenital
+*Congenital
-** Hirschsprung's disease
+**[[Hirschsprung disease]]
-== Clinical Presentation ==
+==Clinical Manifestations==
-* Abdominal pain
+*Abdominal pain
-* Signs of sepsis
+*Signs of sepsis
-** Fever
+**Fever
-** Hypotension
+**Hypotension
-** Shock
+**Shock
-* Signs of IBD (usually ulcerative colitis)
+*Signs of IBD (usually ulcerative colitis)
-* May be first presentation of IBD
+*May be first presentation of IBD
-== Investigations ==
+==Investigations==
-* Imaging:
+*Imaging:
-** Abdominal X-ray will show colon dilated &gt; 6cm
+**Abdominal X-ray will show colon dilated &gt; 6cm
-== Diagnosis ==
+==Diagnosis==
-* Radiographic evidence of colonic distension
+*Radiographic evidence of colonic distension
-* Plus at least three of:
+*Plus at least three of:
-** Fever &gt; 38ºC
+**Fever &gt; 38ºC
-** Heart rate &gt; 120bpm
+**Heart rate &gt; 120bpm
-** WBC &gt; 10.5
+**WBC &gt; 10.5
-** Anemia
+**Anemia
-* Plus at least one of:
+*Plus at least one of:
-** Volume depletion
+**Volume depletion
-** Altered sensorium
+**Altered sensorium
-** Electrolyte abnormalities
+**Electrolyte abnormalities
-** Hypotension
+**Hypotension
-== Management ==
+==Management==
-* Conservative
+*Conservative
-** Bowel rest, NG tube
+**Bowel rest, NG tube
-** If IBD: steroids
+**If IBD: steroids
-** If infectious: antibiotics
+**If infectious: antibiotics
-* If conservative treatment fails, proceed to surgery for subtotal colectomy and end-ileostomy
+*If conservative treatment fails, proceed to surgery for subtotal colectomy and end-ileostomy
 [[Category:Gastroenterology]]