Toxic megacolon classification: Difference between revisions
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{{CMG}}; {{AE}} {{F.K}} | {{CMG}}; {{AE}} {{F.K}} | ||
==Overview== | ==Overview== | ||
Toxic megacolon may be classified according to etiology into two groups including toxic megacolon associated with inflammatory bowel disease and toxic megacolon associated with Clostridium difficile pseudomembranous colitis. | Toxic megacolon may be classified according to etiology into two groups including toxic megacolon associated with [[inflammatory bowel disease]] and toxic megacolon associated with [[Clostridium difficile|''Clostridium difficile'']] [[pseudomembranous colitis]]. | ||
==Classification== | ==Classification== | ||
*There is no established system for the classification of toxic megacolon but it may be classified according to etiology into 2 groups:<ref name="pmid1344622">{{cite journal |vauthors=Morón C |title=[The street sales of food and the cholera epidemic in Latin America] |language=Spanish; Castilian |journal=Arch Latinoam Nutr |volume=42 |issue=3 Suppl |pages=36S–40S |year=1992 |pmid=1344622 |doi= |url=}}</ref><ref name="pmid9482465">{{cite journal |vauthors=Sheth SG, LaMont JT |title=Toxic megacolon |journal=Lancet |volume=351 |issue=9101 |pages=509–13 |year=1998 |pmid=9482465 |doi=10.1016/S0140-6736(97)10475-5 |url=}}</ref><ref name="urlToxic Megacolon Complicating a First Course of Crohn’s Disease: About Two Cases (PDF Download Available)">{{cite web |url=https://www.researchgate.net/publication/261883894_Toxic_Megacolon_Complicating_a_First_Course_of_Crohn%27s_Disease_About_Two_Cases |title=Toxic Megacolon Complicating a First Course of Crohn’s Disease: About Two Cases (PDF Download Available) |format= |work= |accessdate | *There is no established system for the classification of toxic megacolon but it may be classified according to etiology into 2 groups:<ref name="pmid1344622">{{cite journal |vauthors=Morón C |title=[The street sales of food and the cholera epidemic in Latin America] |language=Spanish; Castilian |journal=Arch Latinoam Nutr |volume=42 |issue=3 Suppl |pages=36S–40S |year=1992 |pmid=1344622 |doi= |url=}}</ref><ref name="pmid9482465">{{cite journal |vauthors=Sheth SG, LaMont JT |title=Toxic megacolon |journal=Lancet |volume=351 |issue=9101 |pages=509–13 |year=1998 |pmid=9482465 |doi=10.1016/S0140-6736(97)10475-5 |url=}}</ref><ref name="urlToxic Megacolon Complicating a First Course of Crohn’s Disease: About Two Cases (PDF Download Available)">{{cite web |url=https://www.researchgate.net/publication/261883894_Toxic_Megacolon_Complicating_a_First_Course_of_Crohn%27s_Disease_About_Two_Cases |title=Toxic Megacolon Complicating a First Course of Crohn’s Disease: About Two Cases (PDF Download Available) |format= |work= |accessdate=}}</ref><ref name="pmid3981266">{{cite journal |vauthors=Croswell SC, Lei KY |title=Effect of copper deficiency on the apolipoprotein E-rich high density lipoproteins in rats |journal=J. Nutr. |volume=115 |issue=4 |pages=473–82 |year=1985 |pmid=3981266 |doi= |url=}}</ref><ref name="pmid18953191">{{cite journal |vauthors=Earhart MM |title=The identification and treatment of toxic megacolon secondary to pseudomembranous colitis |journal=Dimens Crit Care Nurs |volume=27 |issue=6 |pages=249–54 |year=2008 |pmid=18953191 |doi=10.1097/01.DCC.0000338869.70035.2b |url=}}</ref><ref name="pmid18277885">{{cite journal |vauthors=Berman L, Carling T, Fitzgerald TN, Bell RL, Duffy AJ, Longo WE, Roberts KE |title=Defining surgical therapy for pseudomembranous colitis with toxic megacolon |journal=J. Clin. Gastroenterol. |volume=42 |issue=5 |pages=476–80 |year=2008 |pmid=18277885 |doi=10.1097/MCG.0b013e31804bbe12 |url=}}</ref><ref name="pmid7352781">{{cite journal |vauthors=Grieco MB, Bordan DL, Geiss AC, Beil AR |title=Toxic megacolon complicating Crohn's colitis |journal=Ann. Surg. |volume=191 |issue=1 |pages=75–80 |year=1980 |pmid=7352781 |pmc=1344622 |doi= |url=}}</ref><ref name="pmid11682295">{{cite journal |vauthors=Imbriaco M, Balthazar EJ |title=Toxic megacolon: role of CT in evaluation and detection of complications |journal=Clin Imaging |volume=25 |issue=5 |pages=349–54 |year=2001 |pmid=11682295 |doi= |url=}}</ref><ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1552156/pdf/gut00731-0009.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref><ref name="pmid10823437">{{cite journal |vauthors=Maccioni F, Viscido A, Broglia L, Marrollo M, Masciangelo R, Caprilli R, Rossi P |title=Evaluation of Crohn disease activity with magnetic resonance imaging |journal=Abdom Imaging |volume=25 |issue=3 |pages=219–28 |year=2000 |pmid=10823437 |doi= |url=}}</ref> | ||
{| | {| | ||
!Etiology of toxic megacolon | ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Etiology of toxic megacolon | ||
!Pathological evolution | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Pathological evolution | ||
!CT scan findings | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |CT scan findings | ||
!MRI findings | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |MRI findings | ||
|- | |- | ||
|Toxic megacolon associated with ulcerative colitis | | rowspan="2" style="background:#DCDCDC;" align="center" + |Toxic megacolon associated with [[inflammatory bowel disease]] | ||
| | | style="background:#DCDCDC;" align="center" + |Toxic megacolon associated with [[ulcerative colitis]] | ||
| style="background:#F5F5F5;" + | | |||
* Rapid damage involving all layers of the colonic wall | * Rapid damage involving all layers of the colonic wall | ||
* Toxins cause a breach in the protective mucosal barrier leading to exposure of muscularis propria | * Toxins cause a breach in the protective mucosal barrier leading to exposure of muscularis propria | ||
| | | style="background:#F5F5F5;" + | | ||
| | * Colonic [[dilation]] | ||
* Mucosal [[edema]] ([[thumbprint sign]]) | |||
| rowspan="4" style="background:#F5F5F5;" + | | |||
* Contrast [[MRI]] is superior to CT for visualization of the anal [[sphincter]] complex and the pelvis (especially in case of [[Crohn's disease]] | |||
* Bowel wall hyperintensity and hyper-enhancement | |||
* Bright enhancement of mucosa (due to inflammation) and hypoenhancing submucosa (due to edema) | |||
|- | |- | ||
|Toxic megacolon associated with Crohn's disease | | style="background:#DCDCDC;" align="center" + |Toxic megacolon associated with [[Crohn's disease]] | ||
| | | style="background:#F5F5F5;" + | | ||
* Occurs early in the course of Crohn's disease | * Occurs early in the course of [[Crohn's disease]] | ||
* Develops more commonly in pancolitis than in segmental disease | * Develops more commonly in [[pancolitis]] than in segmental disease | ||
* Cytomegalovirus infection may be a trigger | * [[Cytomegalovirus]] infection may be a trigger | ||
| | | style="background:#F5F5F5;" + | | ||
* Colonic [[dilation]] | |||
* Mucosal [[edema]] ([[thumbprint sign]]) | |||
* Lead-pipe appearance of the [[colon]] | |||
|- | |- | ||
|Toxic megacolon associated with Clostridium difficile pseudomembranous colitis | | colspan="2" style="background:#DCDCDC;" align="center" + |Toxic megacolon associated with [[Clostridium difficile|''Clostridium difficile'']] [[pseudomembranous colitis]] | ||
| | | style="background:#F5F5F5;" + | | ||
* 0.3-4 percent of cases of pseudomembranous colitis may develop toxic megacolon | * 0.3-4 percent of cases of [[pseudomembranous colitis]] may develop toxic megacolon | ||
* Toxic megacolon is thought to develop secondary to inflammatory changes that penetrate into the muscularis propria leading to neural injury, altered colonic motility and colonic dilation | * Toxic megacolon is thought to develop secondary to [[inflammatory]] changes that penetrate into the muscularis propria leading to neural injury, altered colonic [[motility]] and colonic [[dilation]] | ||
| | | style="background:#F5F5F5;" + | | ||
* Colonic [[dilation]] | |||
* Mucosal [[edema]] ([[thumbprint sign]]) | |||
* Circumferential colonic wall thickening (accordion sign) consistent with a [[pancolitis]] | |||
|- | |- | ||
|Toxic megacolon associated with ischemic colitis | | colspan="2" style="background:#DCDCDC;" align="center" + |Toxic megacolon associated with [[ischemic colitis]] | ||
| | | style="background:#F5F5F5;" + | | ||
| | | style="background:#F5F5F5;" + | | ||
* Colonic [[dilation]] | |||
* Mucosal [[edema]] ([[thumbprint sign]]) | |||
|} | |} | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category: | [[Category:Surgery]] | ||
[[Category:Gastroenterology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
Latest revision as of 17:16, 8 December 2017
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Toxic Megacolon Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Toxic megacolon classification On the Web |
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American Roentgen Ray Society Images of Toxic megacolon classification |
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Risk calculators and risk factors for Toxic megacolon classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
Toxic megacolon may be classified according to etiology into two groups including toxic megacolon associated with inflammatory bowel disease and toxic megacolon associated with Clostridium difficile pseudomembranous colitis.
Classification
- There is no established system for the classification of toxic megacolon but it may be classified according to etiology into 2 groups:[1][2][3][4][5][6][7][8][9][10]
| Etiology of toxic megacolon | Pathological evolution | CT scan findings | MRI findings | |
|---|---|---|---|---|
| Toxic megacolon associated with inflammatory bowel disease | Toxic megacolon associated with ulcerative colitis |
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| Toxic megacolon associated with Crohn's disease |
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| Toxic megacolon associated with Clostridium difficile pseudomembranous colitis |
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| Toxic megacolon associated with ischemic colitis |
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References
- ↑ Morón C (1992). "[The street sales of food and the cholera epidemic in Latin America]". Arch Latinoam Nutr (in Spanish; Castilian). 42 (3 Suppl): 36S–40S. PMID 1344622.
- ↑ Sheth SG, LaMont JT (1998). "Toxic megacolon". Lancet. 351 (9101): 509–13. doi:10.1016/S0140-6736(97)10475-5. PMID 9482465.
- ↑ "Toxic Megacolon Complicating a First Course of Crohn's Disease: About Two Cases (PDF Download Available)".
- ↑ Croswell SC, Lei KY (1985). "Effect of copper deficiency on the apolipoprotein E-rich high density lipoproteins in rats". J. Nutr. 115 (4): 473–82. PMID 3981266.
- ↑ Earhart MM (2008). "The identification and treatment of toxic megacolon secondary to pseudomembranous colitis". Dimens Crit Care Nurs. 27 (6): 249–54. doi:10.1097/01.DCC.0000338869.70035.2b. PMID 18953191.
- ↑ Berman L, Carling T, Fitzgerald TN, Bell RL, Duffy AJ, Longo WE, Roberts KE (2008). "Defining surgical therapy for pseudomembranous colitis with toxic megacolon". J. Clin. Gastroenterol. 42 (5): 476–80. doi:10.1097/MCG.0b013e31804bbe12. PMID 18277885.
- ↑ Grieco MB, Bordan DL, Geiss AC, Beil AR (1980). "Toxic megacolon complicating Crohn's colitis". Ann. Surg. 191 (1): 75–80. PMC 1344622. PMID 7352781.
- ↑ Imbriaco M, Balthazar EJ (2001). "Toxic megacolon: role of CT in evaluation and detection of complications". Clin Imaging. 25 (5): 349–54. PMID 11682295.
- ↑ "www.ncbi.nlm.nih.gov" (PDF).
- ↑ Maccioni F, Viscido A, Broglia L, Marrollo M, Masciangelo R, Caprilli R, Rossi P (2000). "Evaluation of Crohn disease activity with magnetic resonance imaging". Abdom Imaging. 25 (3): 219–28. PMID 10823437.