Table 3.

Key Points to Keep in Mind when managing Toxic Megacolon

Key points of the Review Article:
1. Toxic megacolon (TM) was thought to be a complication for ulcerative colitis (UC) specifically. Later on, the Crohn’s disease (CD) was found to be a cause, and gradually it becomes evident that any inflammatory condition of the colon could predispose to TM.
2. Accurate history and physical examination, plain radiographs of the abdomen, sigmoidoscopy and, most important of all, awareness of the condition facilitate diagnosis in most cases.
3. The most common cause of hospital admission included Inflammatory bowel disease (IBD) (51.6%), followed by septicemia (10.2%) and intestinal infections (4.1%).
4. Computed tomography of the abdomen with contrast is usually performed to establish the diagnosis and also evaluating for complications that may require immediate surgery. Baseline and serial abdominal x rays are then performed to follow the progression of colonic dilatation.
5. Patients should be admitted and evaluated, preferably in the intensive care unit, with frequent examinations to assess for signs of toxicity.
6. Both medical and surgical teams should co-manage patients on admission with daily evaluation.
7. Female gender, age more than 40 years, hypoalbuminemia, acidosis, and high blood urea nitrogen levels are associated with high mortality in a previous study. This patient population requires a special attention from the admission.
8. It is important to examine the abdomen for hepatic dullness every day in patients who have severe colitis and are taking high-dose glucocorticoids because they might have a free perforation and not have classic signs of peritonitis.
9. The main goal for treatment for TM is to treat the underlying inflammation, restoring colonic motility, and preventing free colonic perforation.
10. In HIV infection patients with TM, an aggressive search for infectious and noninfectious causes is essential, including early limited endoscopy and imaging studies. Patients with cytomegalovirus (CMV) colitis or C. difficile infection respond poorly to medical therapy and often require emergent subtotal colectomy and ileostomy.
11. Women with known risk factors for toxic megacolon (most commonly ulcerative colitis) should plan conception during a state of remission.