Toxic megacolon: Difference between revisions
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**Hydrocortisone IV 100mg q6h | **Hydrocortisone IV 100mg q6h | ||
*Triple Antibiotic Therapy | *Triple Antibiotic Therapy | ||
**Ampicillin 2 g IV q6h PLUS Metronidazole 500mg IV q6h PLUS Gentamicin 7mg/kg q24h or Ciprofloxacin 400mg IV q12h | **[[Ampicillin]] 2 g IV q6h PLUS [[Metronidazole]] 500mg IV q6h PLUS [[Gentamicin]] 7mg/kg q24h or [[Ciprofloxacin]] 400mg IV q12h | ||
**OR [[Imipenem]] 500mg IV q6h | **OR [[Imipenem]] 500mg IV q6h | ||
*Electrolyte Repletion | *Electrolyte Repletion | ||
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*Obtain blood cultures, stool cultures, C. Diff Toxin | *Obtain blood cultures, stool cultures, C. Diff Toxin | ||
*If known cause is C. Diff treat with Vancomycin or Metronidazole | *If known cause is C. Diff treat with [[Vancomycin]] or [[Metronidazole]] | ||
*If known cause is CMV can add Ganciclovir | *If known cause is CMV can add Ganciclovir | ||
Revision as of 04:33, 5 December 2016
Background
- Colonic Dilation ≥6cm
- Therapy: Fluids, Electrolyte Repletion, Steroids, Antibiotics, Surgical Consultation
- AVOID anticholingerics, anti-motility agents, opioids
Causes
- Most commonly IBD
- Bacterial
- Salmonella, Shigella, Campylobacter, C. Diff, Yersnia, E. Coli
- Viral
- CMV, Rotavirus
- Fungal/Protozoa
- Aspergillus, Entamoeba, Cryptosporidium
- Drugs
- Anti-motility agents, anticholinergics, opioids
- Less Common Causes
- Ischemic Colitis, Collagenous Colitis, Obstructive Colorectal Cancer, Colonic Lymphoma, Kaposi's Sarcoma, Chemotherapy
- Pediatric Population
- HIV/AIDS Population
- CMV, C. Diff
Clinical Features
- Abdominal Pain ± Distention
- Fever
- Tachycardia
- Diarrhea, ± Bloody
- Hypotension
- Altered Mental Status (AMS)
- Bowel perforation
Differential Diagnosis
- Small bowel obstruction
- Large Bowel Obstruction
- Volvulus, Neoplastic Disease, Paralytic ileus, Pseudo-obstruction
- Colitis
- Infectious, Inflammatory, Ischemic
Evaluation
Toxic megacolon on KUB
- Plain abdominal radiographs:
- Colonic Dilation ≥6 cm diameter
- Loss of haustra, "thumb-printing" (bowel edema)
- Air-fluid levels
- Abdominal Ultrasound:
- Thin colonic walls with loss of haustra coli
- Diameter ≥6cm with gaseous content
- Labs:
- Leukocytosis
- Electrolyte disturbances: Hypokalemia, Hypomagnesemia
- Elevated ESR/CRP
- Anemia
- Hypoalbuminemia
Management
- Fluid Resuscitation
- IV corticosteroids
- Hydrocortisone IV 100mg q6h
- Triple Antibiotic Therapy
- Ampicillin 2 g IV q6h PLUS Metronidazole 500mg IV q6h PLUS Gentamicin 7mg/kg q24h or Ciprofloxacin 400mg IV q12h
- OR Imipenem 500mg IV q6h
- Electrolyte Repletion
- Aggressively treat hypokalemia and hypomagnesemia because these can exacerbate dilation
- Emergent Surgical Consultation
- Obtain blood cultures, stool cultures, C. Diff Toxin
- If known cause is C. Diff treat with Vancomycin or Metronidazole
- If known cause is CMV can add Ganciclovir
- Avoid
- Anticholinergics, anti-motility agents, opioids which can worsen dilation
- Sulfasalazine or 5-aminosalicylate (5-ASA) unhelpful
- Nasogastric (NG) Tube NOT effective in reducing colonic distention
Disposition
- Admit
See Also
References
- Autenrieth, Daniel M., and Daniel C. Baumgart. "Toxic Megacolon." Inflammatory Bowel Diseases 18.3 (2012): 584-91.
- Rosen, Peter, and John A. Marx. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia: Elsevier Saunders, 2014.