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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 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
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