Toxic megacolon: the knee-elbow position relieves bowel distension.

Panos, Marios Z.; Wood, Morgan; Asquith, P.

doi:10.1136/gut.34.12.1726

Cited by 38 publications

(15 citation statements)

References 7 publications

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“…Some authors recommend prone positioning for 10 to 15 min every 2 to 3 h allowing the passage of flatus. Panos et al [22] presented two cases where bowel decompression was successfully achieved with the kneechest position.…”

Section: Discussionmentioning

confidence: 99%

“…These medications include anticholinergics, antidepressants, antidiarrheals, and narcotics [6,13,30] . Surgical intervention may be necessary in up to 80% of patients with toxic megacolon due to C. difficile colitis [22] . Indications for surgery include: perforation, progressive dilation of the colon, lack of clinical improvement over the first 4872 h and uncontrolled bleeding [9,13,21,26,31,32] .…”

Section: Discussionmentioning

confidence: 99%

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Toxic megacolon associatedClostridium difficilecolitis

Sayedy

Kothari²,

Richards

2010

WJGE

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Toxic megacolon is a severe complication of Clostridium difficile (C. difficile ) colitis. As the prevalence of C. difficile colitis increases and treatments become more refractory, clinicians will encounter more patients with C. difficile associated toxic megacolon in the future. Here, we review a case of toxic megacolon secondary to C. difficile colitis and review the current literature on diag nosis and management. We identify both clinical and radiologic criteria for diagnosis and discuss both medical and surgical options for management. Ultimately, we recommend using the Jalen criteria in conjunction with daily abdominal radiographs to help establish the dia gnosis of toxic megacolon and to make appropriate treat ment recommendations. Aggressive medical manage ment using supportive measures and antibiotics should remain the mainstay of treatment. Surgical intervention should be considered if the patient does not clinically improve within 23 d of initial treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Toxic megacolon associatedClostridium difficilecolitis

Sayedy

Kothari²,

Richards

2010

WJGE

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“…Repositioning techniques include rolling maneuvers 55 and a prone knee-elbow position of the patient. 65 However, performing those maneuvers in clinical routine may be impracticable.…”

Section: Managementmentioning

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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“…Maximization of physical activity and positional changes can be beneficial [11]. The patient should be mobilized or periodically turned from side to side and also placed in the knee-chest position [12]. • Conservative measures often also include intestinal decompression using nasogastric suction and insertion of a rectal canula, with or without the aid of a rigid proctoscope.…”

Section: Treatmentmentioning

confidence: 99%

Acute colonic pseudo-obstruction (Ogilvie’s syndrome)

Tack

2006

Curr Treat Options Gastro

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Acute colonic pseudo-obstruction is a complication that occurs in hospitalized patients with serious underlying medical or surgical conditions; it is characterized by acute colonic dilatation in the absence of mechanical obstruction. The pathogenesis is incompletely elucidated, but changes in autonomic nervous system function are likely to contribute, as are metabolic and pharmacologic factors. Early diagnosis and appropriate intervention are critical in this disorder, which carries with it considerable morbidity and mortality. Treatment options, consecutively applied, include conservative measures, pharmacologic treatment with neostigmine, and endoscopic decompression. Surgical decompression or resection is necessary in case of refractoriness or perforation, respectively.

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Toxic megacolon: the knee-elbow position relieves bowel distension.

Cited by 38 publications

References 7 publications

Toxic megacolon associatedClostridium difficilecolitis

Toxic megacolon associatedClostridium difficilecolitis

Toxic megacolon

Acute colonic pseudo-obstruction (Ogilvie’s syndrome)

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