Toxic megacolon: Difference between revisions
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| − | == |
+ | ==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 |
| − | ** |
+ | **''[[Clostridioides difficile]]'' |
| − | ** |
+ | **''[[Entamoeba histolytica]]'' |
| − | ** |
+ | **''[[Shigella]]'' |
| − | * |
+ | *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 |
[[Category:Gastroenterology]] |
[[Category:Gastroenterology]] |
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Latest revision as of 06:53, 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
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
