General

Toxic Megacolon

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4 Sep 2016 - General
 

Toxic megacolon is characterized by total or segmental dilation of the colon plus systemic toxicity, which is two or more of the following criteria : 1.) tachycardia with a pulse rate of greater than 100 beats per minute. 2.) Temperature of greater than 38 celcius. 3.) leucocytosis of greater than 100,000 cells/mm3 4.) Hypoalbuminemia of less than 3.0 g/dL. Is it a potential serious complication of inflammatory bowel disease. If suspected patient having toxic megacolon, a plain film abdomen should be obtained immediately, in which the transverse or right colon will usually dialted of greater than 6cm, and sometime can be up to 15cm.(see photo attched) If confirmed the diagnosis of toxic megacolon, CT-ABD is important to rule ot or look for perforation or vascular compromise.

You Yi Hong To answer your question, well I really have not seen patients presenting around 15-16 year with Hirschsprung disease. I work in a children's hospital, and the children who are treated here are all below 12 years. anyone above that goes to an adult surgical ward, and I do not have prior experience in a adult surgical ward. But I think it would be possible for someone to be asymptomatic till that ag...
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Yes, Theekshana Abayawickrama, true, if you are working in the tertiary referral centre, you will have all the chance to deal with or see a fair amount of uncommon cases. Just wondering, you are mentioning that some cohort of patients with Hirschung disease do presents when they are 10-12 years old with constipation and they are relatively asymptomatic prior to that, then will it possible that Hirschung disease ca...
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You Yi Hong Hirschsprung is fairly commonly seen in paediatric surgical wards. Not that Hirschsprung disease alone is very common, but since there are very few paediatric surgical units in the country, children get referred from all over the country to tertiary care hospitals like the one I am working in. You are right. Many patients with Hirschsprung disease are diagnosed in infancy or early childhood. A carefu...
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Toxic megacolon is a dangerous condition which is characterized by the swelling of the intestine. Almost all the cases are reported as complications of the two types of inflammatory bowel disease which are crohns disease and ulcerative colitis. Intensive inflammation can proceed to the mucsle layer of the colon and may damage the mucsle, affecting the peristalsis and making a dialated sac like colon. Patients present with swollen abdomen, abdominal pan and fever. It is an emergency which should ...
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Yes, Theekshana Abayawickrama colonic dilatation can also occurred in other medical conditions, like Hirschsprung’s disease, mechanic obstruction, colonic pseudo-obstruction, gastrointestinal dysmotility, occurring with chronic constipation. Toxic megacolon can occur as a severe complication of clostridium difficile colitis as well. I have encountered a few cases of toxic megacolon as a complications of inflammat...
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We recently had a patient with a similar looking xray abdomen. It was a previously well 10 year old child. There were huge dilated distal bowel loops. And the child had most of the clinical features that are in the criteria for toxic megacolon. He was running high fever and developed sepsis. He had to be put on inotrophes and initial resuscitation was done in the intensive care unit. We went ahead and did a lower GI contrast study and the probable differential diagnosis was Hirschsprung colitis....
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