Toxic megacolon medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

Medical therapy of Toxic megacolon include:

• 1.General considerations
  • 1.1.Complete bowel rest
  • 1.2.Intravenous fluid support to
  • 1.3.Electrocytes monitoring and correction of abnormalities
  • 1.4.Withdrawal of all anticholinergics, antidiarrheal and narcotics
  • 1.5.Rule out infectious etiology
• 2.Decompression
  • 2.1.Rectal tube
  • 2.2.Nasogastric or long nasointestinal tube

  Note: Long intestinal tubes are considered to be more effective than nasogastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance.

  • 2.3.Repositioning maneuvers

  Note: Maneuver 1: Asking patients to roll into the prone position for 10–15 minutes every 2–3 hours and encourage them to pass gas

  Note: Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body

• 3.Medical management
  • 3.1.Toxic megacolon associated with inflammatory bowel disease(IBD)
    • 3.1.1.Corticosteroids
      • Preferred regimen(1): Hydrocortisone 100 mg IV q6h
      • Preferred regimen(2): Methylprednisolone 60 mg IV q24h
    • 3.1.2.Immunosuppresants
      • Preferred regimen(1): Cyclosporin 2 mg/kg q24h for 7 days

      Note: Maintain serum levels between 150 to 250 ng/mL

      • Preferred regimen(2): Infliximab 5 mg/kg for 3 to 7 days
  • 3.2.Toxic megacolon associated with Clostridium difficile
    • Preferred regimen (1): Vancomycin 500 mg PO q6h or via a nasogastric tube AND Metronidazole 500 mg IV q8h
• 4.Surgical management
  • Failed medical care
  • Progressive toxicity or dilation
  • Signs of perforation