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*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="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="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>
*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="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="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>
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!Etiology of toxic megacolon
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology of toxic megacolon
!Pathological evolution
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Pathological evolution
!CT scan findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |CT scan findings
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|Toxic megacolon associated with ulcerative colitis
|Toxic megacolon associated with ulcerative colitis

Revision as of 18:25, 15 November 2017

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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

Etiology of toxic megacolon Pathological evolution CT scan findings MRI findings
Toxic megacolon associated with ulcerative colitis
  • Rapid damage involving all layers of the colonic wall
  • Toxins cause a breach in the protective mucosal barrier leading to exposure of muscularis propria
  • Colonic dilation
  • Mucosal edema (thumbprint sign)
  • 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
  • Occurs early in the course of Crohn's disease
  • Develops more commonly in pancolitis than in segmental disease
  • Cytomegalovirus infection may be a trigger
  • Colonic dilation
  • Mucosal edema (thumbprint sign)
  • Lead-pipe appearance of the colon
Toxic megacolon associated with Clostridium difficile pseudomembranous colitis
  • 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
  • Colonic dilation
  • Mucosal edema (thumbprint sign)
  • Circumferential colonic wall thickening (accordion sign) consistent with a pancolitis
Toxic megacolon associated with ischemic colitis
  • Colonic dilation
  • Mucosal edema (thumbprint sign)

References

  1. ↑ 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.
  2. ↑ 2.0 2.1 Sheth SG, LaMont JT (1998). "Toxic megacolon". Lancet. 351 (9101): 509–13. doi:10.1016/S0140-6736(97)10475-5. PMID 9482465.
  3. ↑ "Toxic Megacolon Complicating a First Course of Crohn's Disease: About Two Cases (PDF Download Available)".
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ Imbriaco M, Balthazar EJ (2001). "Toxic megacolon: role of CT in evaluation and detection of complications". Clin Imaging. 25 (5): 349–54. PMID 11682295.
  9. ↑ "www.ncbi.nlm.nih.gov" (PDF).
  10. ↑ 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.

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