eMedicine Specialties > Radiology > Gastrointestinal

Toxic Megacolon: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Hemalatha Chandramohan, MBBS, Staff Physician, Department of Geriatric Medicine, Stepping Hill Hospital, United Kingdom
Contributor Information and Disclosures

Updated: Apr 29, 2008

Intervention

The optimal management of severe colitis requires close collaboration between gastroenterologists, intensivists, and surgeons. All patients with severe colitis need to be hospitalized and treated with intravenous steroids. If significant improvement does not follow within 7-10 days, other therapeutic measures (eg, intravenous cyclosporine therapy, surgery) must be considered.25 When surgery is indicated, total colectomy with ileostomy is the appropriate surgical treatment in most cases.26 In patients with toxic megacolon, early surgical intervention is indicated.27

Toxic megacolon secondary to infective colitis is rare in children, but when it occurs, it may be fulminating and potentially fatal. The mortality rate is 15%, and 15% of children require surgery.

Medicolegal Pitfalls

  • The clinical or radiographic features of a toxic megacolon are an absolute contraindication to barium enema examination or the administration of laxatives. Contrast-enhanced studies of the colon should be considered only after the acute symptoms subside and the patient's condition is stabilized.
  • Early surgical intervention is indicated in toxic megacolon and perforation. Conservative medical treatment should not be prolonged in the face of lack of improvement.
  • In children, toxic megacolon secondary to infective colitis can be severe, and it has a high mortality rate. Therefore, early diagnosis and aggressive treatment are important.
 


More on Toxic Megacolon

Overview: Toxic Megacolon
Imaging: Toxic Megacolon
Follow-up: Toxic Megacolon
Multimedia: Toxic Megacolon
References
[ CLOSE WINDOW ]

References

  1. Hanauer SB, Wald A. Acute and chronic megacolon. Curr Treat Options Gastroenterol. Jun 2007;10(3):237-47. [Medline].

  2. Eckel F, Huber W, Weiss W. Recurrent pseudomembranous colitis as a cause of recurrent severe sepsis. Z Gastroenterol. Apr 2002;40(4):255-8. [Medline].

  3. Chaudhuri A, Bekdash BA. Toxic megacolon due to Salmonella: a case report and review of the literature. Int J Colorectal Dis. Jul 2002;17(4):275-9. [Medline].

  4. Herman BE, Vargo J, Phillips WS. Antibiotic-associated fulminant pseudomembranous colitis without toxic megacolon. Am J Gastroenterol. Dec 1992;87(12):1816-9. [Medline].

  5. Mohite U, Kell J, Haj MA, O'Brien C, Kundu S, Rees J, et al. Invasive aspergillosis localised to the colon presenting as toxic megacolon. Eur J Haematol. Mar 2007;78(3):270-3. [Medline].

  6. Hayes-Lattin BM, Curtin PT, Fleming WH. Toxic megacolon: a life-threatening complication of high-dose therapy and autologous stem cell transplantation among patients with AL amyloidosis. Bone Marrow Transplant. Sep 2002;30(5):279-85. [Medline].

  7. McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol. Feb 2007;28(2):140-5. [Medline].

  8. Taege AJ, Adal KA. Clostridium difficile diarrhea and colitis: a clinical overview. Cleve Clin J Med. Sep 1999;66(8):503-7. [Medline].

  9. Kato H, Kato H, Nakamura M, Nakamura A. A case of toxic megacolon secondary to Clostridium difficile-associated diarrhea worsened after administration of an antimotility agent and molecular analysis of recovered isolates. J Gastroenterol. Jun 2007;42(6):507-8. [Medline].

  10. Latella G, Vernia P, Viscido A. GI distension in severe ulcerative colitis. Am J Gastroenterol. May 2002;97(5):1169-75. [Medline].

  11. Gan SI, Beck PL. A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management. Am J Gastroenterol. Nov 2003;98(11):2363-71. [Medline].

  12. Meuwissen SG, Vandenbroucke-Grauls CM, Geboes K. Spectrum of acute self-limiting colitis: role of the clinician and pathologist. Ital J Gastroenterol Hepatol. Nov 1999;31(8):807-16. [Medline].

  13. Monkemuller KE, Wilcox CM. Diagnosis and treatment of colonic disease in AIDS. Gastrointest Endosc Clin N Am. Oct 1998;8(4):889-911. [Medline].

  14. Hanauer SB, Wald A. Acute and chronic megacolon. Curr Treat Options Gastroenterol. Jun 2007;10(3):237-47. [Medline].

  15. Cheung O, Regueiro MD. Inflammatory bowel disease emergencies. Gastroenterol Clin North Am. Dec 2003;32(4):1269-88. [Medline].

  16. Gore RM, Ghahremani GG. Radiologic investigation of acute inflammatory and infectious bowel disease. Gastroenterol Clin North Am. Jun 1995;24(2):353-84. [Medline].

  17. Kawamoto S, Horton KM, Fishman EK. Pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation. Radiographics. Jul-Aug 1999;19(4):887-97. [Medline].

  18. Plewa MC. Emergency abdominal radiography. Emerg Med Clin North Am. Nov 1991;9(4):827-52. [Medline].

  19. Rothrock SG, Green SM, Harding M. Plain abdominal radiography in the detection of acute medical and surgical disease in children: a retrospective analysis. Pediatr Emerg Care. Oct 1991;7(5):281-5. [Medline].

  20. Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol. 2007;21(4):671-87. [Medline].

  21. Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol. 2007;21(4):671-87. [Medline].

  22. De Backer AI, Van Overbeke LN, Mortele KJ. Inflammatory pseudopolyposis in a patient with toxic megacolon due to pseudomembranous colitis. JBR-BTR. 2001;84(5):201. [Medline].

  23. Imbriaco M, Balthazar EJ. Toxic megacolon: role of CT in evaluation and detection of complications. Clin Imaging. Sep-Oct 2001;25(5):349-54. [Medline].

  24. Bennink R, Peeters M, D''Haens G. Tc-99m HMPAO white blood cell scintigraphy in the assessment of the extent and severity of an acute exacerbation of ulcerative colitis. Clin Nucl Med. Feb 2001;26(2):99-104. [Medline].

  25. Berman L, Carling T, Fitzgerald TN, Bell RL, Duffy AJ, Longo WE, et al. Defining Surgical Therapy for Pseudomembranous Colitis With Toxic Megacolon. J Clin Gastroenterol. Mar 13 2008;[Medline].

  26. Berman L, Carling T, Fitzgerald TN, Bell RL, Duffy AJ, Longo WE. Defining Surgical Therapy for Pseudomembranous Colitis With Toxic Megacolon. J Clin Gastroenterol. Feb 6 2008;[Medline].

  27. Berg DF, Bahadursingh AM, Kaminski DL. Acute surgical emergencies in inflammatory bowel disease. Am J Surg. Jul 2002;184(1):45-51. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

severe colitis, segmental dilatation of the colon, total dilatation of the colon, ulcerative colitis, pancolitis, acute transmural fulminant colitis, Crohn disease, Crohn's disease, antibiotic-induced pseudomembranous colitis, amebiasis, Salmonella enteritis, S enteritis, Campylobacter enteritis, C enteritis, ischemic colitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Institute of Ultrasound in Medicine, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Hemalatha Chandramohan, MBBS, Staff Physician, Department of Geriatric Medicine, Stepping Hill Hospital, United Kingdom
Disclosure: Nothing to disclose.

Medical Editor

Neela Lamki, MD, Professor, Department of Radiology, Sultan Qaboos University, Oman; Adjunct Professor, Department of Radiology, Baylor College of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

David Andrew Nicholson, BM, BS, FRCR, Honorary Lecturer, Department of Radiology, University of Manchester; Consultant Gastrointestinal Radiologist, Department of Radiology, Hope Hospital, Salford Royal Hospital NHS Trust
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.