Megacolon, a Complication of Ulcerative Colitis

Rh, Marshak; Lj, Lester

doi:10.1016/s0016-5085(19)36490-x

Cited by 71 publications

(16 citation statements)

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“…In this situation, the colonic lumen dilates to a diameter of 6 cm or more, there is evidence of toxicity (dehydration, hypotension, mental status change, or electrolyte abnormalities) and the patient has at least three of the following: • fever above 38.6°C • tachycardia above 120 beats per minute • leukocytosis above 10 500 cells/mm 3 , or • anemia [108,678,679].…”

Section: Toxic Megacolonmentioning

confidence: 99%

Inflammatory Bowel Disease

Stenson

Hanauer

Cohen

2008

Textbook of Gastroenterology

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In the US, H. pylori vacA shows allelic variation in the signal sequence (which may be type sla, slb or s2) and the mid-region (type ml or m2). Previous PCR-based vacA mid-region typing classified most, but not all, Asian and South American strains tested as ml or m2. We now sought to investigate vacA mid-region diversity further.MotlmodL We studied 13 Japanese, 6 Chinese, 9 Thai, and 8 Peruvian H. pylori isolates. cagA was identified by colony hybridisation (CH), vacA signal sequence was typed by PCR, and vacA mid-region was typed proximally by CH and distally by PCR. Sections of the vacA mid-region from 8 strains were PCR-amplified, sequenced, and compared with known sequences from 8 other strains.Rcuts Of the 36 Asian and South American strains studied, 35 were cagA+ (the cagA-was Peruvian) and 35 were vacA sla (1 cagA + Peruvian was slb). vacA mid-regions from the 13 Japanese strains were not PCR-amplified by ml or m2-specific primers, but hybridised weakly with an ml probe. Sequence analysis of vacA from 1 Japanese strain revealed 91% nucleotide identity with the ml probe but only 71% identity with the m2 probe. The previously equivocal Thai and Peruvian strains also had ml-like mid-region sequences. A Chinese strain was ml in the proximal mid-region and m2 distally, showing a clear crossover site. Final mid-region types were: Japanese, all 13 ml; Chinese, 1 ml, 1 ml/m2, 4 m2; Thai, 3 ml, 6 m2; Peruvian 4 ml, 4 m2. Distal mid-region sequences of 16 strains, compared over 294 bp, clustered into 2 groups, ml and m2. Nucleotide identity between ml and m2 strains ranged from 73-78%. Within groups, m2 strains were less diverse than ml strains (m2 range 94-99.7%, ml 88-99.3%, p<0.001). Sequence analysis of 7 ml and 3 m2 strains over 1.1kb proximally showed maintenance of clustering outside the 294bp region C duions These Asian and South American strains are similar in terms of cagA status and vacA sla genotype, but fall into 2 vacA midregion groups. ml sequences are more diverse than m2, and thus may be phylogenetically older. The vacA sequence of 1 Chinese strain suggests recombination in vivo between ml and m2 alleles. Introduction: H.pylori antimicrobial susceptibility is an important determinant ofthe efficacy of eradication therapies'. The prevalence of antimicrobial resistance varies within the UK and may increase given the increased use of eradication therapy. This multicentre study assesses the prevalence and possible associations ofH.pylon antimicrobial resistance. Methods: H.pylon was isolated from antral biopsies of patients undergoing routine endoscopy and cultured according to standard microbiological methods. Antimicrobial resistance was determined using "E-tests" or disc tests (tinidazole only) with breakpoints defined by previous studies. Results: H.pyloni was isolated from 32% (1222/3823) of patients and antimicrobial susceptibility determined in 90% (1077/1222) Previous case-control studies of IBD have used hospital or community derived controls. There are obvious inherent biases in both metho...

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Section: Toxic Megacolonmentioning

confidence: 99%

Inflammatory Bowel Disease

Stenson

Hanauer

Cohen

2008

Textbook of Gastroenterology

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“…One entity of such fulminant colitis, toxic megacolon (TM), may develop in 0.4-3% of patients with pseudomembranous colitis [10]. TM is defined as segmental or total colonic distension of > 6 cm in the presence of acute colitis and signs of systemic toxicity [11]. In patients who develop TM, mortality rates are high and range from 19-45%, especially if the patient experiences perforation [11].…”

Section: Introductionmentioning

confidence: 99%

“…TM is defined as segmental or total colonic distension of > 6 cm in the presence of acute colitis and signs of systemic toxicity [11]. In patients who develop TM, mortality rates are high and range from 19-45%, especially if the patient experiences perforation [11]. The management of TM must involve both medical and surgical management in a coordinated fashion.…”

Section: Introductionmentioning

confidence: 99%

“…The management of TM must involve both medical and surgical management in a coordinated fashion. Absolute indications for surgery (colectomy) are perforation, progressive dilatation, and uncontrollable bleeding, and given the high mortality after perforation, many authors recommend surgery early after the diagnosis of TM [11,12]. In the case of significant immunosuppression and in particular in neutropenic patients the threshold for surgical intervention should be even lower.…”

Section: Introductionmentioning

confidence: 99%

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Fatal Clostridium difficile-associated toxic megacolon following unrelated stem-cell transplantation

et al. 2006

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Letaler Verlauf eines Clostridium difficileassoziierten toxischen Megakolons nach unverwandter Stammzelltransplantation Zusammenfassung. Grundlagen: Eine nosokomiale Clostridium difficile-assoziierte Kolitis tritt in 1-4 % aller chirurgischen Patienten auf. In 3-5 % kann hieraus ein toxisches Megakolon mit schwerer Sepsis entstehen, welches dann einer chirurgischen Intervention bedarf.Methodik: Fallbericht. Ergebnisse: Bei einer Patientin mit ausgeprägter Neutropenie nach Stammzelltransplantation, die wegen einer akuten lymphatischen Leukämie durchgeführt wurde, entwickelte sich trotz adäquater Therapie mit Metronidazol und Vancomycin ein toxisches Megakolon. Nach erfolgloser medikamentöser Therapie wird zunächst eine Hemikolektomie rechts, dann eine subtotale Kolektomie durchgeführt. Dadurch wird zwar das TM erfolgreich therapiert, jedoch gelingt es der anhaltend neutropenischen Patientin trotzdem nicht sich suffizient zu erholen, sodass sie in ein Multiorganversagen verfällt, in dem sie letztendlich verstirbt.Schlussfolgerungen: Patienten mit zu erwartender länger anhaltender Neutropenie, die ein toxisches Megakolon entwickeln, sollten möglichst rasch mit einer subtotalen Kolektomie operativ behandelt werden, da die Infektion auch unter optimaler antibiotischer Therapie zu einem unkontrollierbarem Mulitorganversagen fortschreiten kann.

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“…TM, an extreme spectrum of fulminant colitis, is characterized by segmental or total colonic dilatation of >6 cm and signs of systemic toxicity [8]. There are numerous causes of TM, such as inflammatory bowel disease, infectious colitides of diverse etiology, ischemic colitis, and nonspecific colitis secondary to chemotherapy and radiotherapy [9].…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus associated toxic megacolon in an immunocompetent host. A case report

et al. 2010

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Zusammenfassung. Grundlagen: Das Zytomegalievirus (CMV) ist erwiesenermaßen eine Ursache letaler Infektionen bei Patienten mit einer Immundysfunktion, wohingegen es bei nicht immungeschwächten Personen vielfach asymptomatisch verläuft oder zu leichten, selbst begrenzenden Infektionen führt.Methodik (Fallbeschreibung): Wir beschreiben den Fall eines durch CMV hervorgerufenen fulminanten toxischen Megakolons bei einem immunkompetenten Patienten. Trotz umfassender Aufarbeitung blieb die ätio-logische Diagnose unklar. Da bei dem Patienten eine schwere Sepsis vorlag, hatte er sich einer notfallmäßigen subtotalen Kolektomie und Splenektomie aufgrund einer Milzentzündung und einer Verwachsung mit dem Kolon zu unterziehen. Der histopathologische Befund zeigte eine CMV-Kolitis mit akuter septischer Splenitis. Postoperativ erholte sich der Patient nach einem längeren Krankenhausaufenthalt gut und wurde entlassen. Ergebnisse und Schlussfolgerungen: Eine CMV-Kolitis ist bei immunkompetenten Individuen ein seltenes Ereignis. Zeigt ein Patient die typischen Manifestationen einer Kolitis und bleibt die Diagnose nach der üblichen Aufarbeitung unklar, besteht der Verdacht auf CMV-Kolitis. Auch nach einer endoskopischen Biopsie, die diesbezüglich als Goldstandard erachtet wird, kann die Diagnose unklar bleiben, da die Biopsie, wie in unserem Fall, möglicherweise nicht in einem repräsentativen Bereich durchgeführt wurde. In einer derartigen Situation sollte man die CMV-Untersuchung von Plasma und Gewebe mittels PCR-Tests in Erwägung ziehen, um zu einer gesicherten Diagnose zu kommen. So kann die antivirale Therapie zum frühestmöglichen Zeitpunkt eingeleitet werden, da die Mortalität bei verzögerter Diagnose inakzeptabel ist. Schlüsselwörter: Zytomegalievirus, Kolitis, toxisches Megakolon, immunkompetent.Summary. Background: Cytomegalovirus (CMV) has been proven to cause lethal infections in patients with immune dysfunction, whereas in normal individuals it is mostly asymptomatic or leads to mild self-limiting infections.Methods (case report): We describe a case of fulminant toxic megacolon caused by CMV in an immunocompetent patient. Etiologic diagnosis remained elusive despite comprehensive workup. As the patient presented with severe sepsis, he underwent emergency subtotal colectomy and splenectomy due to splenic inflammation and adhesion to the colon. Histopathology showed CMV colitis with acute septic splenitis. Postoperatively patient recuperated well after a prolonged hospital course and was discharged.Results and conclusions: CMV colitis in immunocompetent hosts is a rare entity. It should be suspected when a patient has typical manifestations of colitis and the diagnosis remains uncertain after the usual workup. Diagnosis may remain elusive even after endoscopic biopsy, which is considered to be the gold standard, as the biopsy may not be from a representative area, as happened in our case. In such a situation, consideration should be given to plasma or tissue PCR testing for CMV in order to establish the diagnosis, so that...

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Megacolon, a Complication of Ulcerative Colitis

Cited by 71 publications

References 4 publications

Inflammatory Bowel Disease

Inflammatory Bowel Disease

Fatal Clostridium difficile-associated toxic megacolon following unrelated stem-cell transplantation

Cytomegalovirus associated toxic megacolon in an immunocompetent host. A case report

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