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At least 19 recordsLinked to original sources
PubMed2001

[Toxic megacolon].

Toxic megacolon belongs to the severe acute complications of inflammatory bowel diseases. The frequency is 1.6-21.4% among patients with ulcerative colitis and 0.3-2% in those with Crohn's disease. The main characteristics of toxic megacolon are toxemia, sepsis and distension of the colon due to the diminished muscular tone, loss of motor activity and increased amount of colonic gas. Sepsis and/or perforation of the large bowel can complicate this situation. The most important diagnostic procedure is the abdominal X-ray. Should the diameter of colonic distension exceed 60 mm, the diagnosis of toxic megacolon has been confirmed. Conservative treatment of toxic megacolon consists of water and electrolyte replacement, total parenteral nutrition, administration of corticosteroids and broad-spectrum antibiotics and repeat patient's prone positioning. If medical therapy is not successful during the first 72 hours, surgical intervention is indicated. The most common procedure is subtotal colonic resection with creation of an ileostomy. Patients with toxic megacolon should be managed at specialised centers, where cooperation of experienced gastroenterologists, surgeons and intensive care experts is possible.

Humans↗
PubMed1977

Surgical management of toxic megacolon.

Toxic megacolon developed in ten of 220 patients (4.5%) admitted for chronic ulcerative colitis over the past 11 years. Nine of these patients came under the care of the Surgical Department. Only three of these 10 patients had previously been treated with steroids. Steroid therapy reversed the acute process in three patients (33%). All three patients later came to surgery. Toxic megacolon developed during the first episode of ulcerative colitis in seven of ten patients (70%). Three of the seven (43%) had perforated their colons prior to operation. Two patients died after a subtotal colectomy and one without operation. A delayed diagnosis was associated with sepsis in five patients (50%) and with all three deaths. Seven patients survived proctocolectomy. Prolonged medical management without dramatic response appeared to correlate with a high postoperative morbidity. This study supports the concept of aggressive diagnosis and early surgical intervention for toxic megacolon.

Acute Disease↗
PubMed1980

Toxic megacolon.

Toxic megacolon is a clinical entity characterized by fever, tachycardia, and other toxic symptoms and having as its distinguishing feature dilation of a part or all of the colon. It is the result of the acute onset or exacerbation of ulcerative colitis or, less often, granulomatous enterocolitis, amebiasis, or pseudomembranous colitis. The primary inflammatory disease must be accurately identified, and malignant tumors, such as adenocarcinoma and lymphoma, capable of producing clinical findings similar to those of toxic megacolon must be excluded. Aggressive supportive therapy is essential, and early operation to remove the colon is usually necessary to avoid death as a result of this dreaded complication.

Colectomy↗
PubMed1993

Toxic megacolon.

Toxic megacolon, its incidence, differential diagnosis, and presenting signs and symptoms are reviewed in this article. The typical histologic and radiographic features are described with a review of the potential triggering factors. An outline of requirements for adequate monitoring of the patient with toxic megacolon is provided. The general management and specific medical management are discussed in detail, and the medical outcome with both medical and surgical intervention is reviewed.

Colon↗
PubMedDate not supplied

Infliximab in the treatment of ulcerative colitis with toxic megacolon.

Toxic megacolon is a gastrointestinal emergency requiring prompt management to avoid fatal outcome. Although a majority of patients respond to conservative treatment, those not responding have been treated with intravenous cyclosporine or emergency surgery. Infliximab has been tried in patients with severe steroid-refractory ulcerative colitis. We report the successful use of this drug in the management of toxic megacolon in a 48-year-old woman not responding to the routine measures and who refused surgery.

Antibodies, Monoclonal↗
PubMed2000

[Toxic megacolon].

Toxic megacolon is a serious complication of inflammatory bowel disease, thus its prevention should be performed thoroughly. In patients with severe colitis refractory to maximal oral and topical therapy or who presents with toxicity, intravenous steroids are obligatory. If there is failure to achieve significant improvement within 7-10 days colectomy or treatment with intravenous cyclosporine or azathioprine are mandatory. In addition to maximal medical therapy as for severe colitis including broad spectrum antibiotics, patients with toxic megacolon should be kept nil per os, with small bowel decompression tube (if a small bowel ileus is present) and rotated into the prone or knee-elbow position frequently (evacuation of bowel gas). Any clinical, laboratory, or radiological deterioration require immediate colectomy. The duration of medical treatment of megacolon is controversial if no significant improvement is noted. Some experts support surgery within 72 hours, others take a more observing position if no toxic symptoms are present, but some advocate surgery within 24 hours.

Humans↗
PubMed2003

Rescue therapy with tacrolimus in a patient with toxic megacolon.

BACKGROUND: Toxic megacolon is a life-threatening complication most commonly observed in patients with ulcerative colitis or Crohn's disease that is characterized by total or segmental nonobstructive colonic dilatation of at least 6 cm on plain abdominal films associated with systemic toxicity. CASE REPORT: We report an unusual case of fulminant steroid-refractory ulcerative colitis complicated by toxic megacolon treated successfully with the immunosuppressant tacrolimus. CONCLUSION: Tacrolimus administration induced clinical remission and bridged the time interval, until the standard immunosuppressant azathioprine could maintain clinical remission, thereby avoiding eminent emergency colectomy.

Adult↗
PubMed2005

Early surgery for the treatment of toxic megacolon.

BACKGROUND: Toxic megacolon (TM) is a potentially lethal complication of idiopathic inflammatory bowel disease or infectious colitis, characterized by total or segmental non-obstructive colonic dilatation of at least 6 cm associated with systemic toxicity. METHODS: Overall, 15 patients had surgery for TM at our institutions over a 10-year period (1993-2003). In contrast to other studies that used medical therapy as the first-line treatment for TM, in our experience all patients underwent surgery as soon as possible after diagnosis of TM (early surgery). RESULTS: 14 patients underwent subtotal colectomy with terminal ileostomy, while for 1 patient the surgical procedure consisted only in a decompressive cecostomy. Two major complications occurred consisting of 2 cases of multiple organ failure leading to death. No other major complications or deaths were reported. The overall mortality rate was therefore 13% (0% in patients <65 years). CONCLUSION: This study shows that early surgery has the potential to represent a valid therapeutic strategy for patients with TM resulting in a small number of TM-related complications and deaths. Elderly patients seem to have a high risk of multiple organ dysfunction syndrome and post-surgical death.

Adult↗
PubMed2000

Campylobacter jejuni-induced severe colitis--a rare cause of toxic megacolon.

The development of toxic megacolon as a sequel of infectious colitis is rare. We have observed the very rare case of a campylobacter jejuni-induced toxic megacolon. A 28-year-old man was admitted with severe enterocolitis and appearance of blood in stools. He had been treated with loperamide without success. Two days after admission stool cultures revealed campylobacter jejuni and then an oral antibiotic therapy was started. On the fifth day clinical performance deteriorated again with development of toxic megacolon and consecutive subtotal colectomy. Rectoscopy before discharge after 13 days showed a normal mucosa. The unusual course with first improvement and then rapid deterioration despite adequate therapy was observed in 4 other cases, which may also be a hint of ensuing megacolon. Even in usually harmless enterocolitis like campylobacter infection, predisposing factors such as loperamide are known to precipitate toxic megacolon and should be considered in clinical practice.

Adult↗
PubMed1998

[Toxic megacolon: surgical timing important!].

Toxic megacolon is defined as a fulminant attack of colitis with total or segmental dilatation of the colon. Toxic megacolon is mostly a complication of nonspecific ulcerative colitis or Crohn's colitis but it may also occur in pseudomembranous colitis and other forms of infectious colitis. Toxic dilatation of the colon is a sign of transmural acute inflammation in which perforation of the colon is impending or may already have occurred. Free perforation means a fourfold increase in the mortality of a fulminant attack of colitis. Dilatation of the colon is not by itself an indication for immediate operation. The dilatation may increase, fluctuate or even disappear, leaving the patient still severely ill with toxic colitis requiring immediate surgery. The indication and optimal timing of surgical intervention require optimal interdisciplinary collaboration between surgeons and gastroenterologists. The procedure of choice for surgical treatment of toxic megacolon is colectomy and ileostomy. The mortality and morbidity of urgent surgery have been decreased by avoiding rectal excision. The rectal stump is either closed as a pelvic Hartmann's pouch or the sigmoid remnant is exteriorized as a mucous fistula or closed subcutaneously. Progress in intensive therapy and perioperative patient management has relegated simple decompression by diverting loop ileostomy and skin-level colostomy as advocated by Turnbull et al nearly 30 years ago to the role of an obsolete procedure which seems hardly ever preferable to resection of the diseased bowel.

Colectomy↗
PubMed2006

[Toxic megacolon--surgical point of view].

Toxic megacolon is an infrequent, but potentially fatal complication of a fulminant colitis. Toxic colonic dilatation, also caused by ischaemic or infectious inflammation like pseudomembranous colitis, mostly occur in patients with inflammatory bowel disease. Toxic mega-colon is defined as segmental or total colonic distension of >6 cm with the presence of clinical signs of acute colitis and systemic toxicity. Because of the associated high morbidity and mortality the early diagnosis and the management play an important role. The free perforation means a fourfold increase in the mortalitiy of the acute colitis. Recognition of toxic megacolon is underlaying by x-ray of the abdomen with colonic distension and a lack of haustral pattern. Accompanying distension of the small bowel can predict the development of the disease. CT scanning shows a diffuse wall thickening, pericolic inflammation and abnormal haustral pattern and can also detect subclinical perforation or abscesses. The management of toxic megacolon should be with intravenous parenteral nutrition, adaequate supplementation of intravenous fluids and correction of electrolytes abnormalities and the therapy of colitis with corticosteroids. Antibiotics are indicated in infectious disease or bacteriemia and also in colonic perforation. Surgical intervention is indicated by the onset of signs of progression of the disease and complications as perforation, uncontrollable bleeding or distension. The surgical procedure of choice is colectomy and ileostomy. The mortality and morbidity was decreased by avoiding rectal excision. The rectum is closed as a Hartmann's procedure or a mucous fistula is created. A secondary ileoanal pouch can be created at a later date. The interdisciplinary approach with optimal timing of surgical intervention can decrease the morbidity and mortality of toxic megacolon.

Colectomy↗
PubMed1980

Toxic megacolon complicating Crohn's colitis.

Toxic megacolon complicating ulcerative colitis has been a well-recognized entity since its original description in 1950. The presence of toxic megacolon frequently has precluded a diagnosis of Crohn's colitis. Recent literature, however, has demonstrated that the incidence of toxic megacolon associated with Crohn's colitis (4.4-6.3%) may be higher than that in ulcerative colitis (1-2.5%). Differentiation between these two catastrophic forms of colitis is important in respect to prognosis and long-term results. Medical management of toxic megacolon may be initially successful in either type of colitis. Surgical intervention is indicated if the patient's condition does not improve within 48-72 hours. A subtotal colectomy with an ileostomy and mucous fistula is probably the treatment of choice for most of these extremely ill patients. The influence of the type of colitis on the results of subsequent management of the rectal stump remains unresolved.

Adult↗
PubMedDate not supplied

[Toxic megacolon secondary to pseudomembranous colitis].

BACKGROUND: Toxic megacolon is a rare complication of pseudomembranous colitis. OBJECTIVE: The aim of this paper is to present a rare case of toxic megacolon secondary to pseudomembranous colitis. METHODS: The chart of a 75-year-old male, who developed a toxic megacolon secondary to pseudomembranous colitis no was reviewed. RESULTS: The clinical features and outcome of a 75-year-old male with pseudomembranous colitis are depicted. The main symptoms were no ever, abdominal distention, bloody and diarrhea; the man suddenly developed a toxic megacolon and taken was to surgery. Total colectomy with proximal rectal closure was performed. The patient died within 24 hours of the abdominal procedure. CONCLUSIONS: Toxic megacolon is a rare complication of pseudomembranous colitis. Its presence should be suspected when these patients develop no colonic dilatation with associated systemic toxicity. Aggressive surgical intervention is indicated.

Aged↗
PubMed1995

Toxic megacolon complicating pseudomembranous enterocolitis.

PURPOSE: Toxic megacolon is a rare complication of pseudomembranous enterocolitis. We reviewed our recent experience with this complication. METHODS: The first five patients of the series were studied retrospectively, and six others were followed prospectively. RESULTS: Between June 1992 and May 1994, 11 patients (8 male, 3 female) developed toxic megacolon secondary to pseudomembranous enterocolitis. Mean age was 60.7 +/- 11.8 (range, 40-79) years. Presenting symptoms and signs included diarrhea, 100 percent; malaise, 91 percent; abdominal pain, 82 percent; abdominal distention, 82 percent; abdominal tenderness, 72 percent; anemia less than 12 gm, 72 percent; albumin less than 3 gm, 64 percent; tachycardia greater than 100, 55 percent; fever greater than 38.5 degrees celsius, 45 percent; shock or hypotension, 45 percent. Predisposing factors included antibiotics, 64 percent; immunosuppressants or chemotherapy, 36 percent; antidiarrheals, 27 percent; and barium enema in one patient. Five patients (45 percent) had more than one predisposing factor. X-rays showed transverse colon dilation and loss of haustrations in eight patients (72 percent), with a mean diameter of 9.9 +/- 3.4 cm. Flexible proctosigmoidoscopy showed pseudomembranes in all scoped patients, and toxin assay for Clostridium difficile was positive in all patients. One patient had emergency surgery. Ten patients were initially treated medically with nasogastric suction and intravenous resuscitation (90 percent) and antibiotics (100 percent), usually in the intensive care unit (80 percent). Four patients did not respond and underwent surgery; two others improved, then deteriorated, and also underwent surgery. Altogether, 7 of 11 patients (64 percent) underwent surgery. Three patients (27 percent) responded well to medical treatment. One patient was deemed too ill to undergo surgery and died. Mean delay to surgery was 3.0 +/- 1.3 days. No sealed or overt perforation was found at laparotomy. All patients who underwent surgery had a subtotal colectomy, with either a Hartmann's stump (71 percent) or a mucous fistula (29 percent). Eventually, five of seven patients who were operated on and two of four medically treated patients died (overall mortality, 64 percent). Only one patient underwent closure of ileostomy and anastomosis. CONCLUSION: Toxic megacolon complicating pseudomembranous enterocolitis is a serious problem that carries a high morbidity and mortality rate, regardless of treatment.

Adult↗
PubMed2006

[Toxic megacolon--the position of the internist].

Toxic megacolon is a rare but typical complication of ulcerative colitis. But also every inflammatory bowel disease may be cause of toxic megacolon, including especially Crohn's colitis and pseudomembranous colitis (PMC). There is to mention, that PMC becomes more frequent and more important in the last years. Toxic megacolon is defined by radiological, clinical and labaratory criteria: colonic distension (<6 cm), fever, tachycardia, hypotension, electrolyte disturbances, leucocytosis and anemia. Intensive medical therapy is primarly the therapy of choice, but clinical parameters should be closely monitored. In patients with ulcerative colitis high dosis of corticosteroids are given intravenously. If there is no clinical improvement after 48 to 72 hours, colectomy is required. The use of alternative therapies like cyclosporine or infliximab has to be discussed as possible before toxic megacolon occurs.

Adrenal Cortex Hormones↗
PubMed2005

Toxic megacolon complicating Escherichia coli O157 infection.

Toxic megacolon is a well known complication in inflammatory bowel disease such as ulcerative colitis or Crohn's disease. The development of toxic megacolon as a complication of infectious colitis is rare. However it is recognised as a complication of enteric infections caused by Clostridium difficile, Campylobacter jejuni, Shigella, Salmonella species, Cytomegalovirus and amoebae. We describe a case of necrotising haemorrhagic ileo-colitis in a previously fit and healthy young adult female caused by Escherichia coli O157 where toxic megacolon developed as a complication along with hemolytic uremic syndrome (HUS).

Adult↗
PubMedDate not supplied

[Toxic megacolon: physiopathologic mechanism and surgical choices].

Toxic megacolon is the most dreadful complication arising in patients affected with inflammatory bowel diseases. Its incidence is rather rare, bur mortality rate is significantly high (about 40% of cases). Pathological modifications occurring in toxic megacolon deeply influence evolution and prognosis of this complication and, consequently, surgical choices. Starting from the pathophysiology of toxic megacolon, the Authors review their experience with acute colitis, emphasizing the need for a radical treatment, as only total colectomy can assure, versus Turnbull's operation or more decompression of the bowel. To save the colon means, in fact, to leave the source of sepsis "in situ". The authors experienced Turnbull's procedure only in one of the patients observed with "quoad vitam" poor results.

Colitis, Ulcerative↗
PubMedDate not supplied

Toxic megacolon secondary to pseudomembranous colitis.

Toxic megacolon has rarely been reported in the course of antibiotic-induced pseudomembranous colitis. We have been able to collect 20 cases from the literature and add one new case. The mortality in the collected series was 33 per cent. The critical factor in improving survival is early recognition of the pseudomembranous colitis. Most patients can be managed medically by removal of the offending antibiotic, bowel rest, vancomycin, and steroids. If toxic megacolon develops in the face of appropriate medical management, an aggressive surgical approach is indicated, as with ulcerative colitis. Subtotal colectomy appears to be the procedure of choice.

Adult↗