Toxic megacolon: Difference between revisions
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Revision as of 07:15, 28 September 2015
Background
- Inflammation of intestinal smooth muscle causes colon dilation[1]
- Untreated, can lead to perforation
- Usually associated with infectious colitis or Crohn's disease or Ulcerative Colitis
Triggers
- Anti-motility agents
- Anticholinergics
- Narcotics
- Pregnancy
- Enemas
- Recent colonoscopy
Clinical Features
- Abdominal Pain
- Fever
- Tachycardia
- Diarrhea
- Distended abdomen
- Hypokalemia
- Hypomagnesemia
- Bowel perforation
Differential Diagnosis
- Small bowel obstruction
- Large Bowel Obstruction
- Constipation
Colitis
- Viral gastroenteritis
- Bacterial gastroenteritis
- Campylobacter infections
- Clostridium difficile colitis
- Colon cancer
- Crohn disease
- Cryptosporidiosis
- Mycobacterium Avium-Intracellulare
- Toxic megacolon
- Ulcerative colitis
- Ischemic bowel disease (e.g. mesenteric ischemia, strangulated hernia)
- Pseudomembranous enterocolitis
- Lymphoma
- Ileocecal amebiasis
- Sarcoidosis
- Yersinia
- Campylobacter
Diagnosis
- X-ray showing colon > 6 cm diameter
- Can also see loss of haustra, "thumb-printing" (bowel edema)
- Labs:
- leukocytosis
- electrolyte disturbances
- anemia
- hypoalbuminemia
Management
- Fluid hydration
- IV corticosteroids
- Antibiotics to cover bowel flora[2]
- Mild to moderate disease
- Ciprofloxacin 400 mg IV q12h AND metronidazole 1 g IV q12h
- Ticarcillin-clavulanate 3.1 g IV q6h
- Severe disease
- Ampicillin 2 g IV q6h AND metronidazole 500 mg IV q6h AND gentamicin 7mg/kg q24h
- Imipenem 500 mg IV q6h
- Mild to moderate disease
- Early surgical consultation if no improvement in 24-48 hours
Disposition
- Admit