Toxic megacolon
OVERVIEW
- Toxic megacolon is colonic dilation (>6cm) with systemic toxicity, usually due to an acute colitis.
- can involve the whole colon or only one segment.
CAUSES
- Clostridium difficile pseudomembranous colitis
- Other infections – Salmonella, Shigella, Entamoeba
- Inflammatory bowel disease — Ulcerative colitis, Crohn’s disease
- Ischaemic colitis
CLINICAL FEATURES
- abdominal pain
- abdominal distension
- fever
- bloody diarrhoea
- shock
Complications
- perforation
- septic shock
- death
INVESTIGATIONS
- abdominal Xray or CT scan — colonic dilation (diameter > 6cm, loss of haustra).
MANAGEMENT
Conservative management
- aggressive fluid resuscitation +/- vasopressor support
- IV antibiotics (broad spectrum, e.g tazocin)
- NBM and NG tube for bowel decompression
- avoid medications that reducing GI motility (opiates)
if there is no response in 24 – 72 hours usually proceed to surgical intervention/ colectomy.
PROGNOSIS
- Mortality is high, especially if no response conservative management.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC