Toxic megacolon: Difference between revisions
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*Less Common Causes (Ischemic [[Colitis]], Collagenous Colitis, Obstructive Colorectal Cancer, Colonic Lymphoma, [[Kaposi's Sarcoma]], Chemotherapy) | *Less Common Causes (Ischemic [[Colitis]], Collagenous Colitis, Obstructive Colorectal Cancer, Colonic Lymphoma, [[Kaposi's Sarcoma]], Chemotherapy) | ||
*Pediatric Population ([[Hirschsprung's Disease]], [[Hemolytic Uremic Syndrome]]) | *Pediatric Population ([[Hirschsprung's Disease]], [[Hemolytic Uremic Syndrome]]) | ||
*[[HIV]]/AIDS Population (CMV, C. Diff | *[[HIV]]/AIDS Population ([[CMV]], [[C. Diff]]) | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 22:30, 10 February 2021
Background
- Colonic Dilation ≥6cm
- Therapy: Fluids, Electrolyte Repletion, Steroids, Antibiotics, Surgical Consultation
- AVOID anticholingerics, anti-motility agents, opioids
Causes
- Most commonly IBD (Ulcerative Colitis >>> Crohn's disease)
- Bacterial (Salmonella, Shigella, Campylobacter, C. Diff, Yersinia, 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 (Hirschsprung's Disease, Hemolytic Uremic Syndrome)
- 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 derangements: 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