GI distension in severe ulcerative colitis

Latella, Giovanni; Vernia, Piero; Viscido, Angelo; Frieri, Giuseppe; Cadau, G.; Cocco, Andrea; Cossu, Andrea; Tomei, Ernesto; Caprilli, R.

doi:10.1111/j.1572-0241.2002.05691.x

Cited by 74 publications

(32 citation statements)

References 42 publications

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“…In a more recent prospective study toxic megacolon was reported in 7.9% of patients admitted with UC. 5 Until the late 1990s the incidence of toxic megacolon in patients with pseudomembranous colitis (PMC) was reported between 0.4% and 3%. [6][7][8] Over the last decade, however, major changes in the epidemiology of Clostridium difficile infections (CDI) have been observed.…”

Section: Epidemiologymentioning

confidence: 99%

Toxic megacolon

and

Baumgart

2012

Inflammatory Bowel Diseases

122

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Toxic megacolon represents a dreaded complication of mainly inflammatory or infectious conditions of the colon. It is most commonly associated with inflammatory bowel disease (IBD), i.e., ulcerative colitis or ileocolonic Crohn's disease. Lately, the epidemiology has shifted toward infectious causes, specifically due to an increase of Clostridium difficile-associated colitis possibly due to the extensive (ab)use of broad-spectrum antibiotics. Other important infectious etiologies include Salmonella, Shigella, Campylobacter, Cytomegalovirus (CMV), rotavirus, Aspergillus, and Entameba. Less frequently, toxic megacolon has been attributed to ischemic colitis, collagenous colitis, or obstructive colorectal cancer. Toxic colonic dilatation may also occur in hemolytic-uremic syndrome (HUS) caused by enterohemorrhagic or enteroaggregative Escherichia coli O157 (EHEC, EAEC, or EAHEC). The pathophysiological mechanisms leading to toxic colonic dilatation are incompletely understood. The main characteristics of toxic megacolon are signs of systemic toxicity and severe colonic distension. Diagnosis is made by clinical evaluation for systemic toxicity and imaging studies depicting colonic dilatation. Plain abdominal imaging is still the most established radiological instrument. However, computed tomography scanning and transabdominal intestinal ultrasound are promising alternatives that add additional information. Management of toxic megacolon is an interdisciplinary task that requires close interaction of gastroenterologists and surgeons from the very beginning. The optimal timing of surgery for toxic megacolon can be challenging. Here we review the latest data on the pathogenesis, clinical presentation, laboratory, and imaging modalities and provide algorithms for an evidence-based diagnostic and therapeutic approach.

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Section: Epidemiologymentioning

confidence: 99%

Toxic megacolon

and

Baumgart

2012

Inflammatory Bowel Diseases

122

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“…Eighty percent of all cases occur during the first 4 years after diagnosis, and the event is not necessarily correlated with the aggressiveness of the disease [32][33][34][35]. Other less common acute complications of Crohn's disease (especially that involving the colon) include toxic megacolon, which is present in 4.4-6.4 % of patients with colon involvement and is also an early event [36][37][38], and massive hemorrhage, with an incidence of around 1 %. In 15-20 % of patients with large intestinal…”

Section: Clinical Aspectsmentioning

confidence: 99%

Surgery and diagnostic imaging in abdominal Crohn’s disease

et al. 2013

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Surgery is well-established option for the treatment of Crohn's disease that is refractory to medical therapy and for complications of the disease, including strictures, fistulas, abscesses, bleeding that cannot be controlled endoscopically, and neoplastic degeneration. For a condition like Crohn's disease, where medical management is the rule, other indications for surgery are considered controversial, because the therapeutic effects of surgery are limited to the resolution of complications and the rate of recurrence is high, especially at sites of the surgical anastomosis. In the authors' opinion, however, surgery should not be considered a last-resort treatment: in a variety of situations, it should be regarded as an appropriate solution for managing this disease. Based on a review of the literature and their own experience, the authors examine some of the possibilities for surgical interventions in Crohn's disease and the roles played in these cases by diagnostic imaging modalities.Riassunto La chirurgia è un'opzione terapeutica consolidata per il trattamento della malattia di Crohn refrattaria alla terapia medica e per le complicanze legate a tale patologia quali stenosi, fistole, ascessi, sanguinamento non trattabile endoscopicamente, oltre che per i casi di degenerazione neoplastica. Per condizioni come la malattia di Crohn nelle quali il trattamento medico ha un ruolo primario, altre indicazioni per la chirurgia sono controverse, poiché i suoi effetti terapeutici sono limitati alla risoluzione delle complicanze, e la frequenza di recidive è alta, soprattutto a livello dell'anastomosi. Secondo l'opinione degli autori, tuttavia, la chirurgia non deve essere considerata come ultima opzione di trattamento: in diverse situazioni dovrebbe essere ritenuta come una soluzione adeguata nel trattamento multidisciplinare della patologia. Basandosi sulla revisione della letteratura corrente e sulla propria esperienza, gli autori hanno esaminato alcune possibilità di intervento chirurgico nella malattia di Crohn ed il ruolo che svolgono in queste condizioni le tecniche di imaging.

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“…This phenomenon is now more widely known as multiple organ dysfunction syndrome (MODS) and it is considered to be related to the systemic inflammatory response syndrome (SIRS). Recent studies [5, 16] indicate that severe colitis must be included among the causes of MODS. In patients with UC, MODS is frequently preceded by TM and it is responsible for the majority of UC cases with a fatal outcome [16].…”

Section: Discussionmentioning

confidence: 99%

“…Because of the associated high morbidity and mortality, early recognition and management of TM is of paramount importance [5]. The role of medical therapy of TM remains controversial both in infectious and IBD colitis.…”

Section: Introductionmentioning

confidence: 99%

Early Surgery for the Treatment of Toxic Megacolon

et al. 2005

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Background: Toxic megacolon (TM) is a potentially lethal complication of idiopathic inflammatory bowel disease or infectious colitis, characterized by total or segmental non-obstructive colonic dilatation of at least 6 cm associated with systemic toxicity. Methods: Overall, 15 patients had surgery for TM at our institutions over a 10-year period (1993–2003). In contrast to other studies that used medical therapy as the first-line treatment for TM, in our experience all patients underwent surgery as soon as possible after diagnosis of TM (early surgery). Results: 14 patients underwent subtotal colectomy with terminal ileostomy, while for 1 patient the surgical procedure consisted only in a decompressive cecostomy. Two major complications occurred consisting of 2 cases of multiple organ failure leading to death. No other major complications or deaths were reported. The overall mortality rate was therefore 13% (0% in patients <65 years). Conclusion: This study shows that early surgery has the potential to represent a valid therapeutic strategy for patients with TM resulting in a small number of TM-related complications and deaths. Elderly patients seem to have a high risk of multiple organ dysfunction syndrome and post-surgical death.

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GI distension in severe ulcerative colitis

Abstract: In severe UC, persistent GI distension characterized a subgroup of patients with poor response to medical therapy and at higher risk for TMC and of need for surgery. The development of MODS was the most important predicting factor for fatal outcome.

Cited by 74 publications

References 42 publications

Toxic megacolon

Toxic megacolon

Surgery and diagnostic imaging in abdominal Crohn’s disease

Early Surgery for the Treatment of Toxic Megacolon

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