Overview
What is toxic megacolon (toxic colitis)?
What are the diagnostic criteria for toxic megacolon (toxic colitis)?
Which conditions are associated with toxic megacolon (toxic colitis)?
What are serious complications of toxic megacolon (toxic colitis)?
What is the pathophysiology of toxic megacolon (toxic colitis)?
What are the inflammatory causes of toxic megacolon (toxic colitis)?
What are the infectious causes of toxic megacolon (toxic colitis)?
Which conditions cause toxic megacolon (toxic colitis)?
Which factors increase the risk for toxic megacolon (toxic colitis)?
What is the prevalence of toxic megacolon (toxic colitis)?
Which patient groups are at highest risk for toxic megacolon (toxic colitis)?
What is the prognosis of toxic megacolon (toxic colitis)?
What is included in patient education about toxic megacolon (toxic colitis)?
Presentation
What are the signs and symptoms of toxic megacolon (toxic colitis)?
What are the diagnostic criteria for toxic megacolon (toxic colitis)?
Which physical findings are characteristic of toxic megacolon (toxic colitis)?
What are the signs of perforation in toxic megacolon (toxic colitis)?
DDX
What are the differential diagnoses for Toxic Megacolon?
Workup
What is the role of complete blood count (CBC) in the diagnosis of toxic megacolon (toxic colitis)?
What is the role of chemistry panel in the diagnosis of toxic megacolon (toxic colitis)?
Which histologic findings are characteristic of toxic megacolon (toxic colitis)?
What is the role of radiography in the diagnosis of toxic megacolon (toxic colitis)?
What radiographic findings are characteristic of toxic megacolon (toxic colitis)?
What is the role of ultrasonography in the diagnosis of toxic megacolon (toxic colitis)?
What is the role of CT scanning in the diagnosis of toxic megacolon (toxic colitis)?
What is the role of endoscopy in the diagnosis of toxic megacolon (toxic colitis)?
Treatment
How is toxic megacolon (toxic colitis) treated?
What is the role of cyclosporine in the treatment of toxic megacolon (toxic colitis)?
Which new therapies are being investigated for the treatment for toxic megacolon (toxic colitis)?
Which specialist consultations are beneficial to patients with toxic megacolon (toxic colitis)?
Which activity modifications are used in the treatment of toxic megacolon (toxic colitis)?
What is the role of colectomy in the treatment of toxic megacolon (toxic colitis)?
Why is subtotal colectomy the preferred surgical treatment for toxic megacolon (toxic colitis)?
How is total proctocolectomy performed in the treatment of toxic megacolon (toxic colitis)?
What is included in informed consent for surgery to treat toxic megacolon (toxic colitis)?
Medications
What is the role of medications in the treatment of toxic megacolon (toxic colitis)?
Which medications in the drug class Immunomodulators are used in the treatment of Toxic Megacolon?
Which medications in the drug class Corticosteroids are used in the treatment of Toxic Megacolon?
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A 22-year-old man presented with abdominal pain, passage of blood and mucus per rectum, abdominal distention, fever, and disorientation. Findings from sigmoidoscopy confirmed ulcerative colitis. Abdominal radiographs obtained 2 days apart show mucosal edema and worsening of the distention in the transverse colon. The patient's clinical condition deteriorated over the next 36 hours despite steroid and antibiotic therapy, and the patient had to undergo a total colectomy and ileostomy.
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A 72-year-old woman presented with vomiting and abdominal distention. The supine (right) and erect (left) plain abdominal radiographs show gross dilatation of the colon with multiple air-fluid levels. On further questioning, the patient revealed that she was taking diuretics for hypertension. Blood biochemical tests revealed markedly lowered potassium levels. After potassium replacement therapy, the patient's pseudo-obstruction completely resolved.
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Gross pathology specimen from a case of pseudomembranous colitis demonstrating characteristic yellowish plaques.
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Computed tomography scan from a patient with pseudomembranous colitis demonstrating the classic accordion sign.
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Plain abdominal radiograph from a patient with known ulcerative colitis who presented with an acute exacerbation of his symptoms. This image shows thumbprinting in the region of the splenic flexure of the colon.
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Increased postrectal space is a known feature of ulcerative colitis.