Toxic megacolon in ulcerative colitis: a continuing challenge

Muscroft, T. J.; Warren, P.M.; Asquith, P.; Montgomery, R. D.; Sokhi, G. S.

doi:10.1136/pgmj.57.666.223

Cited by 12 publications

(6 citation statements)

References 18 publications

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“…It is a rare but serious complication that occurs among 1.6 to 3% of UC patients, usually during the first severe relapse with involvement of the left half of the colon or pancolitis. 3 Forty percent of patients with TM or fulminant colitis require urgent surgery. 4 Toxic megacolon can be also a complication of any kind of intestinal infections ( Salmonella, Shigella, Campylobacter, Cytomegalovirus ), ischemic colitis, radiation, or obstructive colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

A Case of Severe Ulcerative Colitis with Colonic Dilatation caused by Renal Mucinous Tubular and Spindle Cell Carcinoma

Kukulska

Smoła

Hałoń

et al. 2010

Euroasian Journal of Hepato-Gastroenterology

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We present a case of ulcerative colitis (UC) in a patient during the first severe relapse with colonic dilatation and coexisting of giant renal tumor. Kidney tumor was constricting on colon and imitating toxic megacolon (TM). The patient with severe acute colitis (SAC) was admitted to the Department of Gastroenterology and Hepatology with inflammatory bowel disease (IBD) diagnosed in the previous month, based on clinical symptoms, endoscopy, and histopathology results. Computed tomography (CT) revealed a giant left kidney tumor without evidence of infiltration, a dilatation of the transverse colon up to 6 cm, and narrow light of the descending colon. There were no signs of intestinal obstruction or perforation. The control X-rays revealed maintaining megacolon, with dilatation of splenic flexure projection up to 6.5 to 7.5 cm. The patient was treated conservatively with no apparent improvement and finally operated on. Intraoperatively, a large tumor of the kidney (12 cm) constricting intestine was revealed. Left-sided nephrectomy and partial resection of the colon with the emergence of a colostomy was performed. The histopathology exam revealed renal mucinous tubular and spindle cell carcinoma (RMTSCC), a very rare malignant kidney tumor of low malignant potential and relative good prognosis. It was identified in the past 20 years. To date, approximately 100 such cases of cancer have been described.How to cite this articleKukulska M, Smola I, Halon A, Paradowski L, Poniewierka E, Kempinski R, Annabhani A. A Case of Severe Ulcerative Colitis with Colonic Dilatation caused by Renal Mucinous Tubular and Spindle Cell Carcinoma. Euroasian J Hepato-Gastroenterol 2016;6(2):190-193.

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Section: Discussionmentioning

confidence: 99%

A Case of Severe Ulcerative Colitis with Colonic Dilatation caused by Renal Mucinous Tubular and Spindle Cell Carcinoma

Kukulska

Smoła

Hałoń

et al. 2010

Euroasian Journal of Hepato-Gastroenterology

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“…Toxic megacolon, 43 life-threatening gastrointestinal bleeding 44,45 and thromboembolism 46,47 are severe complications of UC. High mortality was observed in patients with toxic megacolon, and death was usually caused by colonic perforation.…”

Section: Absence Of Crucial Recommendations For Severe Uc Complicationsmentioning

confidence: 99%

“…High mortality was observed in patients with toxic megacolon, and death was usually caused by colonic perforation. 43 Conventional colonic endoscopy is not feasible in this clinical setting, but only two CGPs recommended sigmoidoscopy and plain abdominal X-ray as alternatives (TSIBD-UC 18 EL = 4; AMG-UC 19 EL = 5) (Table 4). No UC-CPGs discussed life-threatening GI bleeding or thromboembolism.…”

Section: Absence Of Crucial Recommendations For Severe Uc Complicationsmentioning

confidence: 99%

Systematic evaluation of the diagnostic approach of inflammatory bowel disease guidelines

Xiao

et al. 2021

Int J Clin Pract

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According to recent research, globally, over a million American and 2.5 million European have IBD, and even low-incidence countries and regions (Asia, the Middle East, South America) have shown an increasing incidence. 1,2 IBD patients suffer from disabilities and discrimination that affects work, study and life, jeopardizing their quality of life. 3 The clinical manifestations of inflammatory bowel disease generally lack specificity (eg, abdominal pain, fatigue, diarrhoea, rectal bleeding) and can include extraintestinal manifestations, and even pulmonary CD, making it likely that IBD is confused with

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“…Salazopyrine has also been shown to be of benefit in acute ulcerative colitis [2] and appears to have a role in the treatment of acute Crohn's colitis [31. Despite this clear definition of management policies, the condition still has a significant mortality even in highly specialized units. The mortality rate may be as high as 30-60% should the complications of toxic megacolon or perforation develop [4][5][6][7][8][9][10][11].…”

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confidence: 99%

Management of acute colitis in inflammatory bowel disease

et al. 1986

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From January 1971 to December 1984, fifty‐three patients presented with severe acute colitis, defined clinically as a temperature above 38°C., a pulse above 100/min, and bloody diarrhea more than 5 times/day. Twenty‐eight patients (12 male) had ulcerative colitis, 25 patients (13 male) had Crohn's colitis. The severe attack occurred earlier in the course of the disease in Crohn's colitis. The mean age for those with Crohn's disease was 31 years (range 17–58) and 41 years (range 17–70) for those with ulcerative colitis. All patients were managed on a combined medical and surgical gastrointestinal unit. The initial treatment was medical; 49 patients received corticosteroids, 40 salazopyrine, and 7 antibiotics. Twenty‐seven patients settled on medical treatment in a mean of 11 days (range 3–30). Of these, 3 required resection later. Twenty‐six patients required urgent operation (panproctocolectomy in 9, total colectomy and ileorectal anastomosis in 11, and colectomy with retention of rectum in 6). Ten patients developed toxic megacolon, 9 requiring urgent surgery. The other one initially settled but had a colectomy later on during the admission. There were no deaths in this series. Postoperative complications were uncommon. No factors on admission could predict the need for an operation. We believe that with close cooperation between experienced physicians and surgeons, mortality and morbidity from severe, fulminating colitis can be avoided.

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Toxic megacolon in ulcerative colitis: a continuing challenge

Cited by 12 publications

References 18 publications

A Case of Severe Ulcerative Colitis with Colonic Dilatation caused by Renal Mucinous Tubular and Spindle Cell Carcinoma

A Case of Severe Ulcerative Colitis with Colonic Dilatation caused by Renal Mucinous Tubular and Spindle Cell Carcinoma

Systematic evaluation of the diagnostic approach of inflammatory bowel disease guidelines

Management of acute colitis in inflammatory bowel disease

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