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February 10, 2011. Toxic Megacolon. Total or segmental nonobstructive colonic dilatation PLUS systemic toxicity Most commonly transverse colon. Toxic Megacolon:Etiology. IBD Infectious colitis C. diff Salmonella, shigella , campylobacter CMV Amoebic colitis Ischemic colitis

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toxic megacolon
Toxic Megacolon

Total or segmental nonobstructive colonic dilatation

PLUS systemic toxicity

Most commonly transverse colon

toxic megacolon etiology
Toxic Megacolon:Etiology
  • IBD
  • Infectious colitis
    • C. diff
    • Salmonella, shigella, campylobacter
    • CMV
    • Amoebic colitis
  • Ischemic colitis
  • Volvulus
  • Diverticulitis
  • Obstructive colon cancer
toxic megacolon precipitating factors
Toxic Megacolon: Precipitating Factors

Hypokalemia

Antimotility agents

Opiates

Anticholinergics

Antidepressants

Barium enema

Colonoscopy

clinical manifestations
Clinical Manifestations

Toxic appearing

Altered sensorium

Hypotension/tachycardia

Fever

Abd distension and tenderness

+/- peritoneal signs

diagnosis
Diagnosis
  • Radiographic colonic distention
  • PLUS 3 of following
    • Fever>38
    • Tachycardia
    • Leukocytosis
    • Anemia
  • PLUS at least 1 of the following
    • Dehydration
    • Altered sensorium
    • Electrolyte disturbances
    • Hypotension
treatment
Treatment
  • Goal: reduce severity of colitis
    • Restore normal motility
    • Decrease likelihood of perforation
  • Medical therapy is successful in preventing surgery in 50%
  • Surgical team should be consulted
treatment1
Treatment
  • Complete bowel rest
  • NG tube
  • ICU monitoring
  • Serial abdominal exams
  • CBC, lytes, KUB q 12
  • Appropriate treatment if IBD present
    • Steroids
  • Avoid steroids for infectious etiology
treatment2
Treatment
  • Broad spectrum abx
    • Third-generation cephalosporin
    • Metronidazole
  • Discontinue
    • Antimotility meds
    • Opiates
    • Anticholinergics
  • Generous IVF
surgery indications
Surgery: Indications

Perforation

No improvement in 3 days

nutrition
Nutrition
  • TPN if needed
  • Resume enteral feedings with first signs of improvement
    • Mucosal healing
    • Motility
c diff and toxic megacolon
C. Diff and Toxic Megacolon

Stop offending agent

Vancomycin PO

Flagyl IV