total or segmental nonobstructive colonic dilatation plus systemic toxicity most commonly...

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 Volvulus Diverticulitis Obstructive colon cancer

Toxic Megacolon: Precipitating Factors

Hypokalemia Antimotility agents Opiates Anticholinergics Antidepressants Barium enema Colonoscopy

Clinical Manifestations Toxic appearing Altered sensorium Hypotension/tachycardia Fever Abd distension and tenderness +/- peritoneal signs

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 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

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

Treatment Broad spectrum abx

• Third-generation cephalosporin• Metronidazole

Discontinue • Antimotility meds• Opiates• Anticholinergics

Generous IVF

Surgery: Indications Perforation No improvement in 3 days

Nutrition TPN if needed Resume enteral feedings with first

signs of improvement• Mucosal healing• Motility

C. Diff and Toxic Megacolon

Stop offending agent Vancomycin PO Flagyl IV