Megacolon in inflammatory bowel disease: response to infliximab

Ortiz, Andrea Núñez; Salado, Claudio Trigo; Ramírez, María Dolores de la Cruz; Galán, José Luis Márquez; Justiniano, José Manuel Herrera; Carnerero, Eduardo Leo

doi:10.17235/reed.2020.6394/2019

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…Changes in Cajal interstitial cell numbers are described in patients with idiopathic megacolon or chronic constipation by numerous studies and suggested as an etiopathogenic basis [18][19][20][21][22][23][24]. They are considered a true intestinal pacemaker ("little brain" at the enteral level); however, starting from the premise that their number decreases physiologically with age anyway and by the fact that a number of other communications do not confirm their involvement in the etiopathogenesis of idiopathic megacolon, this theory remains for the moment only a new subject of controversy [8].…”

Section: Cajal Cellsmentioning

confidence: 99%

Idiopathic Megacolon—Short Review

et al. 2021

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Introduction: Idiopathic megacolon (IM) is a rare condition with a more or less known etiology, which involves management challenges, especially therapeutic, and both gastroenterology and surgery services. With insufficiently drawn out protocols, but with occasionally formidable complications, the condition management can be difficult for any general surgery team, either as a failure of drug therapy (in the context of a known case, initially managed by a gastroenterologist) or as a surgical emergency (in which the diagnostic surprise leads additional difficulties to the tactical decision), when the speed imposed by the severity of the case can lead to inadequate strategies, with possibly critical consequences. Method: With such a motivation, and having available experience limited by the small number of cases (described by all medical teams concerned with this pathology), the revision of the literature with the update of management landmarks from the surgical perspective of the pathology appears as justified by this article. Results: If the diagnosis of megacolon is made relatively easily by imaging the colorectal dilation (which is associated with initial and/or consecutive clinical aspects), the establishing of the diagnosis of idiopathic megacolon is based in practice almost exclusively on a principle of exclusion, and after evaluating the absence of some known causes that can lead to the occurrence of these anatomic and clinical changes, mimetically, clinically, and paraclinically, with IM (intramural aganglionosis, distal obstructions, intoxications, etc.). If the etiopathogenic theories, based on an increase in the performance of the arsenal of investigations of the disease, have registered a continuous improvement and an increase of objectivity, unfortunately, the curative surgical treatment options still revolve around the same resection techniques. Moreover, the possibility of developing a form of etiopathogenic treatment seems as remote as ever.

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Section: Cajal Cellsmentioning

confidence: 99%

Idiopathic Megacolon—Short Review

et al. 2021

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Infliximab

2020

Reactions Weekly

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Surgical Management for Patients with Toxic Megacolon due to Ulcerative Colitis

Watanabe,

Higashi,

Kaida

et al. 2024

J Anus Rectum Colon

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Objectives: The present study reviewed cases of Toxic megacolon (TM) treated in our department, summarized the timing and technique of surgery, and considered key points for surgical management. Methods: This single-center retrospective study included the medical records of patients clinically diagnosed with TM who underwent surgery between 1985 and 2020. The diagnostic criteria and screening scores for sepsis, such as the systemic inflammatory response syndrome (SIRS) criteria, quick Sequential Organ Failure Assessment (qSOFA) score, and Modified Early Warning Score (MEWS), were validated. The preoperative clinical features and perioperative findings were also investigated. Results: There were eight male and six female patients. Nine patients (64.3%) satisfied the criteria for toxemia proposed by Narabayashi, and 10 patients (71.4%) fulfilled the SIRS criteria. A positive qSOFA score was confirmed in 1 patient (7.1%). The MEWS was high in 2 patients (14.3%). Intestinal perforation occurred in 2 patients (14.3%), and 1 of them died from disseminated intravascular coagulation. The mortality rate of TM with perforation was 50%. Eleven patients (78.6%) underwent total colectomy with end ileostomy. Conclusions: TM does not have well-defined diagnostic criteria, in addition to developing sometimes as borderline or fulminant cases, and must be recognized at an early stage, taking various findings into consideration. The criteria proposed by Narabayashi and the SIRS criteria, which met in a high percentage of our cases, are recommended as indicators for determining the toxicity of TM. It is also important to consider surgery in the early stages of TM, even if clinical findings do not meet all the criteria.

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Megacolon in inflammatory bowel disease: response to infliximab

Cited by 3 publications

References 10 publications

Idiopathic Megacolon—Short Review

Idiopathic Megacolon—Short Review

Infliximab

Surgical Management for Patients with Toxic Megacolon due to Ulcerative Colitis

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