Management of Severe Colitis and Toxic Megacolon

Overview

Journal Clin Colon Rectal Surg

Date 2024 Oct 14

PMID 39399135

Authors

Marjorie R Liggett

Hasan B Alam

Affiliations

Soon will be listed here.

Abstract

Severe colitis is a well-defined condition encompassing several etiologies but is most often caused by severe ulcerative colitis or infection. Severe colitis can evolve into toxic colitis, or toxic megacolon when associated with bowel dilation and systemic manifestations, resulting in a life-threatening scenario where multidisciplinary management is often required. Medical management continues to play an important role in the initial treatment of toxic megacolon. However, timely surgical intervention can be lifesaving.

Citing Articles

Toxic Megacolon: A Sequelae of Clostridioides difficile Infection in a Case of Necrotizing Fasciitis.

Bhargava A, Mahakalkar C, Kshirsagar S, Yachmaneni A Cureus. 2024; 16(1):e53034.

PMID: 38410289 PMC: 10895553. DOI: 10.7759/cureus.53034.

References

Khanna S, Shin A, Kelly C . Management of Clostridium difficile Infection in Inflammatory Bowel Disease: Expert Review from the Clinical Practice Updates Committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017; 15(2):166-174. DOI: 10.1016/j.cgh.2016.10.024. View

Strong S . Management of acute colitis and toxic megacolon. Clin Colon Rectal Surg. 2011; 23(4):274-84. PMC: 3134807. DOI: 10.1055/s-0030-1268254. View

Jalan K, Sircus W, CARD W, FALCONER C, Bruce C, CREAN G . An experience of ulcerative colitis. I. Toxic dilation in 55 cases. Gastroenterology. 1969; 57(1):68-82. View

Peprah D, Chiu A, Jean R, Pei K . Comparison of Outcomes Between Total Abdominal and Partial Colectomy for the Management of Severe, Complicated Clostridium Difficile Infection. J Am Coll Surg. 2018; 228(6):925-930. PMC: 6535364. DOI: 10.1016/j.jamcollsurg.2018.11.015. View

Longo W, Mazuski J, Virgo K, Lee P, Bahadursingh A, Johnson F . Outcome after colectomy for Clostridium difficile colitis. Dis Colon Rectum. 2004; 47(10):1620-6. DOI: 10.1007/s10350-004-0672-2. View

Moulin V, Dellon P, Laurent O, Aubry S, Lubrano J, Delabrousse E . Toxic megacolon in patients with severe acute colitis: computed tomographic features. Clin Imaging. 2011; 35(6):431-6. DOI: 10.1016/j.clinimag.2011.01.012. View

Dickinson R, OConnor H, Pinder I, Hamilton I, Johnston D, Axon A . Double blind controlled trial of oral vancomycin as adjunctive treatment in acute exacerbations of idiopathic colitis. Gut. 1985; 26(12):1380-4. PMC: 1433117. DOI: 10.1136/gut.26.12.1380. View

McKenna N, Bews K, Mathis K, Lightner A, Habermann E . Surgery During Admission for an Ulcerative Colitis Flare: Should Pouch Formation Be Considered?. J Surg Res. 2019; 239:216-223. DOI: 10.1016/j.jss.2019.02.014. View

da Luz Moreira A, Vogel J, Baker M, Mor I, Zhang R, Fazio V . Does CT influence the decision to perform colectomy in patients with severe ulcerative colitis?. J Gastrointest Surg. 2008; 13(3):504-7. DOI: 10.1007/s11605-008-0732-3. View

10.

Ahmed N, Kuo Y, Guinto R, Purewal J . Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system. Eur J Trauma Emerg Surg. 2021; 48(3):2013-2022. DOI: 10.1007/s00068-021-01769-y. View

11.

TRUELOVE S, Witts L . Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955; 2(4947):1041-8. PMC: 1981500. DOI: 10.1136/bmj.2.4947.1041. View

12.

Burkart N, Kwaan M, Shepela C, Madoff R, Wang Y, Rothenberger D . Indications and Relative Utility of Lower Endoscopy in the Management of Clostridium difficile Infection. Gastroenterol Res Pract. 2011; 2011:626582. PMC: 3199093. DOI: 10.1155/2011/626582. View

13.

Mantzaris G, Petraki K, Archavlis E, Amberiadis P, Kourtessas D, Christidou A . A prospective randomized controlled trial of intravenous ciprofloxacin as an adjunct to corticosteroids in acute, severe ulcerative colitis. Scand J Gastroenterol. 2001; 36(9):971-4. DOI: 10.1080/003655201750305503. View

14.

Arnell T . Surgical management of acute colitis and toxic megacolon. Clin Colon Rectal Surg. 2009; 17(1):71-4. PMC: 2780071. DOI: 10.1055/s-2004-823073. View

15.

Navaneethan U, Mukewar S, Venkatesh P, Lopez R, Shen B . Clostridium difficile infection is associated with worse long term outcome in patients with ulcerative colitis. J Crohns Colitis. 2012; 6(3):330-6. DOI: 10.1016/j.crohns.2011.09.005. View

16.

Kulaylat A, Kassam Z, Hollenbeak C, Stewart Sr D . A Surgical Clostridium-Associated Risk of Death Score Predicts Mortality After Colectomy for Clostridium difficile. Dis Colon Rectum. 2017; 60(12):1285-1290. DOI: 10.1097/DCR.0000000000000920. View

17.

Sartelli M, Di Bella S, McFarland L, Khanna S, Furuya-Kanamori L, Abuzeid N . 2019 update of the WSES guidelines for management of () infection in surgical patients. World J Emerg Surg. 2019; 14:8. PMC: 6394026. DOI: 10.1186/s13017-019-0228-3. View

18.

Poylin V, Hawkins A, Bhama A, Boutros M, Lightner A, Khanna S . The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection. Dis Colon Rectum. 2021; 64(6):650-668. DOI: 10.1097/DCR.0000000000002047. View

19.

Juo Y, Sanaiha Y, Jabaji Z, Benharash P . Trends in Diverting Loop Ileostomy vs Total Abdominal Colectomy as Surgical Management for Clostridium difficile Colitis. JAMA Surg. 2019; 154(10):899-906. PMC: 6613305. DOI: 10.1001/jamasurg.2019.2141. View

20.

Bojic D, Radojicic Z, Nedeljkovic-Protic M, Al-Ali M, Jewell D, Travis S . Long-term outcome after admission for acute severe ulcerative colitis in Oxford: the 1992-1993 cohort. Inflamm Bowel Dis. 2009; 15(6):823-8. DOI: 10.1002/ibd.20843. View