A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management

Gan, S Ian; Beck, Paul L.

doi:10.1111/j.1572-0241.2003.07696.x

Cited by 196 publications

(96 citation statements)

References 77 publications

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“…Th e absolute dimension to defi ne a " megacolon " has been variably defi ned and may be considered as total or segmental nonobstructive dilation to ≥ 6 cm. Hypokalemia or hypomagnesemia, which can exacerbate dilation, should be aggressively corrected ( 260,261 ). In patients with either toxic signs (fever, leukocytosis, or worsening symptoms) or megacolon, medications with anticholinergic or narcotic properties should be avoided for possibility of worsening colonic atony or dilatation, as increased colonic and small intestinal gas is a predictor of a poor outcome to medical therapy ( 262 -265 ).…”

Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,156

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,156

977

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“…Ischemic colitis is another cause for toxic megacolon. Cytomegalovirus colitis, Cryptosporidia infection, and Kaposi’s sarcoma have also been reported to cause toxic megacolon in patients with human immunodeficiency virus infection 4. Drugs that slow colonic motion, including anti‐diarrhoeal and anti‐cholinergics, has been reported to be associated with development of toxic megacolon.…”

Section: Discussionmentioning

confidence: 99%

First reported case of afatinib‐associated toxic megacolon

Kwok

Tam

Lam

2018

Respirology Case Reports

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We report the first case of toxic megacolon associated with afatinib use, which is a potentially fatal complication, with risks of colonic perforation. In this case, the condition improved on stopping afatnib. Clinicians need to be alert of this rare but fatal adverse effect and to avoid anti‐diarrhoeal agents, which can worsen toxic megacolon. Anti‐diarrhoeal agents are routinely given if diarrhoea occurs on afatinib. These should be stopped and avoided if toxic megacolon occurs.

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“…Colectomy is indicated as an emergency in cases of perforation, toxic megacolon, massive rectal bleeding or multi-visceral failure [9]. These complications have become less common since the early management of severe inflammatory colitis.…”

Section: Discussionmentioning

confidence: 99%

Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases

Abid¹,

Babakhouya²,

Mellouki³

et al. 2018

OJGas

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Background: Severe acute colitis is a common complication of inflammatory bowel disease (IBD). Their diagnosis is based on clinical, laboratory, endoscopic and radiological. The severe acute colitis is a medical and surgical emergency; its mortality is 1% to 3%. The management should be swift and coordinated, upon admission, between medical and surgical teams. Methods: This is a retrospective study in Gastroenterology Service at the University Hospital HASSAN II Fez, over a period of 10 years (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). We included all patients admitted for severe acute colitis; all the epidemiological, clinical, endoscopic, histological, and therapeutic monitoring of patients were collected. Results: We collected 123 patients. Their average age was 35 years (16 -70). It was a female predominance (sex ratio F/M = 1.19). 54 patients were admitted for an inaugural severe acute colitis (43%), while 69 patients were known carriers of IBD (56%). All patients were admitted to an array of severe acute colitis according to the criteria of Truelove and Witts modified. 9 patients were operated urgently because there was the presence of complications (5 cases of perforation, 3 cases of massive rectal bleeding, and one patient with an abscess in the right iliac fossa). Corticosteroids intravenously was administered to 114 patients, 74 patients (64%) had remission. Patients who have not responded to corticosteroids IV (N = 40): 1) 12 patients received treatment with oral cyclosporine: the remission rate was 66%. 2) 8 patients were put under Infliximab: The response rate was 75%. 3) Patients who have not responded to a second-line treatment underwent subtotal colectomy with a dual stoma. 4) The surgery was indicated as a second-line treatment in 20 patients who all received a subtotal colectomy with double stoma; totalizing colectomy and ileoanale anastomosis ware made in 4 patients. The mortality rate is higher in our series (12%) mainly postoperatively; it is due to the delayed admission of patients, which promotes the development of complications. Conclusion: Acute Severe Ulcerative Colitis is a medical and surgical emergency

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A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management

Cited by 196 publications

References 77 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

First reported case of afatinib‐associated toxic megacolon

Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases

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