Toxic megacolon natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Common complications of toxic megacolon include perforation, bleeding, shock, sepsis.
Natural History
- If left untreated, toxic megacolon in patients with ulcerative colitis lead to death in 0.2% patients.[1]
- The following factors are associated with increased mortality:[2][3]
- Age>40 years
- Female gender
- Lower albumin level
- Lower serum CO2
- High BUN
- The duration of inflammatory bowel disease do not affect mortality.[4][5]
- There is recurrence rate of approximately 29% for patients of either toxic megacolon or fulminant colitis.[6]
Complications
- Common complications of toxic megacolon include:[7][3]
- Perforation or opening in the wall of the colon
- Bleeding
- Shock
- Sepsis
Prognosis
- Depending on the presence of the perforation at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as excellent without perforation.[5][8]
- Early surgical management leads to better prognosis when compared to medical management.[6]
- Majority of patients of toxic megacolon treated with medical management requires colectomy on long term follow up.[2][9]
References
- ↑ Witte J, Shivananda S, Lennard-Jones JE, Beltrami M, Politi P, Bonanomi A, Tsianos EV, Mouzas I, Schulz TB, Monteiro E, Clofent J, Odes S, Limonard CB, Stockbrügger RW, Russel MG (2000). "Disease outcome in inflammatory bowel disease: mortality, morbidity and therapeutic management of a 796-person inception cohort in the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD)". Scand. J. Gastroenterol. 35 (12): 1272–7. PMID 11199366.
- ↑ 2.0 2.1 Greenstein AJ, Sachar DB, Gibas A, Schrag D, Heimann T, Janowitz HD, Aufses AH (1985). "Outcome of toxic dilatation in ulcerative and Crohn's colitis". J. Clin. Gastroenterol. 7 (2): 137–43. PMID 4008909.
- ↑ 3.0 3.1 Sayedy, Leena (2010). "Toxic megacolon associatedClostridium difficilecolitis". World Journal of Gastrointestinal Endoscopy. 2 (8): 293. doi:10.4253/wjge.v2.i8.293. ISSN 1948-5190.
- ↑ 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.
- ↑ 5.0 5.1 Grant CS, Dozois RR (1984). "Toxic megacolon: ultimate fate of patients after successful medical management". Am. J. Surg. 147 (1): 106–10. PMID 6691535.
- ↑ 6.0 6.1 Gan, S. Ian; Beck, P. L. (2003). "A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management". The American Journal of Gastroenterology. 98 (11): 2363–2371. doi:10.1111/j.1572-0241.2003.07696.x. ISSN 0002-9270.
- ↑ Autenrieth DM, Baumgart DC (2012). "Toxic megacolon". Inflamm. Bowel Dis. 18 (3): 584–91. doi:10.1002/ibd.21847. PMID 22009735.
- ↑ Trudel JL, Deschênes M, Mayrand S, Barkun AN (1995). "Toxic megacolon complicating pseudomembranous enterocolitis". Dis. Colon Rectum. 38 (10): 1033–8. PMID 7555415.
- ↑ Strauss RJ, Flint GW, Platt N, Levin L, Wise L (1976). "The surgical management of toxic dilatation of the colon: a report of 28 cases and review of the literature". Ann. Surg. 184 (6): 682–8. PMC 1345407. PMID 999345.