Patient will present as → a patient brought into the emergency room appearing quite ill. He has a fever of 103.2°F, dry skin and oral mucosal membranes, and abdominal distention and tenderness. His medical history is significant for ulcerative colitis.
Toxic megacolon is usually a complication of inflammatory bowel disease, such as ulcerative colitis and, more rarely, Crohn's disease, and of some infections of the colon, including Clostridium difficile infections, which have led to pseudomembranous colitis.
- Life-threatening form of colon distention
- Pt will present with FEVER, markedly distended abdomen with peritonitis and shock
- KUB shows dilated colon > 6 cm
- Common in patients with Ulcerative Colitis and Crohn's disease
Toxic megacolon is diagnosed based on clinical signs of systemic toxicity combined with radiographic evidence of colonic dilatation (diameter >6 cm)
- Radiographic evidence of colonic distension
- PLUS at least three of the following:
- Fever >38ºC
- Heart rate >120 beats/min
- Neutrophilic leukocytosis >10,500/microL
- Anemia
- PLUS at least one of the following:
- Dehydration
- Altered sensorium
- Electrolyte disturbances
- Hypotension
Decompression of the colon is required
- In some cases, colostomy or even complete colonic resection may be required
Question 1 |
Hirschsprung’s disease Hint: presents with chronic constipation. Patients are not usually toxic except when intestinal perforation occurs. | |
Cytomegalovirus colitis Hint: Occurs in immunocompromised persons. | |
Toxic megacolon | |
Kaposi’s sarcoma Hint: Occurs in immunocompromised persons. |
Question 2 |
Radiographic evidence of colonic dilatation (>6cm) Hint: See C for explanation | |
Fever (>101.50F) Hint: See C for explanation | |
Blood pressure > 150/90 | |
Heart rate > 120/min Hint: See C for explanation |
Question 3 |
Ulcerative colitis Hint: See B for explanation | |
Pancreatitis | |
Crohn colitis Hint: See B for explanation | |
Pseudomembranous colitis Hint: See B for explanation |
Question 4 |
Dilated colon (>6 cm). Hint: See C for explanation | |
Loss of colonic haustrations. Hint: See C for explanation | |
Frimann Dahl sign. | |
Segmental colonic parietal thinning. Hint: See C for explanation |
Question 5 |
Placing of intravenous line for rehydration and electrolyte correction. Hint: See D for explanation | |
Administration of broad spectrum intravenous antibiotics. Hint: See D for explanation | |
Passage of a nasogastric tube for decompression. Hint: See D for explanation | |
Administration of an antidiarrheal agent. |
List |
References: Merck Manual · UpToDate