<p>Toxic Megacolon: Background, Pathophysiology, Management Challenges and Solutions</p>

Abstract

Toxic megacolon (TM) is one of the fatal complications of inflammatory bowel disease (IBD) or any infectious etiology of the colon that is characterized by total or partial nonobstructive colonic dilatation and systemic toxicity. It is associated with high morbidity and mortality, and surgical management is necessary for the majority of the cases. An accurate history and physical examination, plain radiographs of the abdomen, sigmoidoscopy, and, most important of all, awareness of the condition facilitate diagnosis in most cases. Operative intervention is warranted when massive hemorrhage, perforation, or peritonitis complicate the clinical scenario or medical therapy fails to control the disease. We sought to review the management challenges of TM and its possible management strategies in this article.

Toxisches Megakolon

“…Ein toxisches Megakolon manifestiert sich klinisch am häufigsten durch blutige Diarrhöen. Im Zuge dessen sowie als Zeichen der systemischen Toxizität können die Patienten zudem folgende Symptome zeigen: Hypotonie, Tachykardie, Fieber, diffuse abdominelle Schmerzen mit und ohne Peritonitis sowie fehlende Darmperistaltik als Ausdruck einer Paralyse (Desai et al 2020). Als seltene aber schwerwiegendste Komplikation mit einem 3-bis 5-fach erhöhten Letalitätsrisiko gilt die Kolonperforation (Doshi et al 2018;Grieco et al 1980), die auch ohne eine Darmdistension einhergehen kann (Desai et al 2020;Greenstein et al 1986).…”

Colitis ulcerativa para no gastroenterólogos

“…Colitis fulminante y megacolon tóxico: la presencia de más de 10 deposiciones al día, sangrado rectal continuo y compromiso sistémico caracterizan clínicamente a la colitis fulminante, condición de riesgo para desarrollar megacolon tóxico y definido radiológicamente por un diámetro colónico transverso ≥6 cm o un diámetro cecal >9 cm. Debe considerarse infección por C. difficile o citomegalovirus como precipitantes (11,12).…”

“…Perforación espontanea: descrita en alrededor del 8 % de los casos. Se manifiesta con dolor abdominal intenso y signos de irritación peritoneal (11,12).…”

An unusual cause of toxic megacolon

“…Computed tomography of the abdomen is the imaging modality of choice in patients with suspected megacolon but abdominal radiographs can be useful in monitoring colonic dilation 2. Toxic megacolon requires prompt surgical review, but because of the absence of an acute abdomen in this patient, immediate surgical intervention was not warranted and symptoms rapidly responded to treatment.…”