Toxic megacolon, have you seen it?

Toxic megacolon is an acute complication seen in various types of colitis
.
This is due to fulminant colitis, which leads to loss of neurogenic tone in the colon, leading to severe dilation and increasing the risk of
perforation.

etiology

Ulcerative colitis is the most common cause, and other less common causes of toxic megacolon and colitis include:

This colon (typically transverse colon) expands to at least 6 cm
.

Treatment and prognosis

Specific treatment depends on the underlying cause and may involve a combination of
supportive, pharmacological, and surgical treatments.

Be practical

Due to the danger of perforation, barium meal examination and colonoscopy should be avoided
.

CASE M20 Abdominal pain, diarrhea, and vomiting worsen for 3 days
.
tachycardia, fever with elevated
inflammatory markers.
Case contributed by Dr Vu Tran

There is a large amount of excretion in the rectum and distal part of the sigmoid, and the rest of the colon is widened and can reach 8 cm
in diameter.
More fecal matter
can be seen in the cecum and ascending colon.
The small bowel is not dilated and may reflect a well-functioning
ileal valve.

The pericolonic wall thickens, mesenteric veins are filled
.

Conclusion:
long colitis from the rectum to the splenic curvature with significant flatulence
.
These possibilities include infectious and inflammatory E.
coli.

In this case, the appearance of the swelling may coincide with
toxic megacolon.

Meets the clinical criteria
for toxic megacolon.
Transverse colon dilation 8.
5 cm
.
Fever 38 °C on admission, heart rate > 148, tachycardia, anemia, serum magnesium 0.
51mmol/L, phosphate 0.
44mol/L at admission, electrolyte imbalance is severe
.

Start with a flexible sigmoidoscopy
.
It shows diffuse severe inflammation in the descending colon (below).

Colitis is accompanied by ulcers and pustules
.

He then underwent laparoscopic assisted total colectomy and ileostomy
.
The findings included a very enlarged upper rectum, 14 cm
long.

Histopathology Report: Macroscopic description: Total colectomy:

colectomy specimen consisting of two segments of bowel
.
The large segment consists of
30×20 mm of the small intestine.
Appendix 40x8 mm, colon and cecum 270 mm, diameter 120 mm
.
The serous surface is diffuse hyperemic
.
The intestinal wall thins
in some parts.
The surface of the mucous membrane is diffuse tan and ulcerate.

The second segment is 440 mm long and up to 85 mm
in diameter.
The serous surface is also hyperemic
.
The thickness of the intestinal wall is between
1 mm and 5 mm.
The surface of the mucous membrane ulcerates and is
brownish.
The diameter of the 4 lymph nodes is 6mm~13 mm
.

Microscopic description:
colon sections show extensive mucosal bleeding, focal erosions covered
with fibrinolytic purulent exudate.
There is no severe deformation to indicate chronic colitis
.
The lamina propria is infiltrated by a large number of macrophages with pigments
.
There is no obvious diffuse active inflammation, and lymphatic aggregation is dominated
by the mucous membrane.
No granulomas
were found.
The submucosal layer is characterized by massive edema, severe hyperemia, and focal bleeding
.
Most sites retain the muscles propria, and no muscle fiber necrosis or degeneration
is seen.
The intestine is significantly weakened in some places with mucosal ulceration and neutrophil infiltration, extending into the submucosal layer
.
No perforations
were found.
The proximal and distal colonic margins of the ileum show relatively normal live bowel
.
No dysplasia or malignancy
.
Focal acute mucosal inflammation
may be seen in the appendix.
All lymph nodes show only slight reactive changes
.
Features are consistent
with toxic megacolon.

Diagnosis: total colectomy: toxic megacolon
.

He was discharged 26 days after surgery
.

Retrospective etiological analysis of 70 cases of toxic megacolon treated by surgery in 1985~2004: 46% were ulcerative colitis, 34% were infectious colitis, and 11% were ischemic colitis
.

A positive stool test for Clostridium Clostridium CASE M suggests toxic colitis
.

Diffuse colonic dilation and wall thickening with dilation
.
Distal small bowel stool sign
.

Typical features Toxic megacolon is caused by clostridial infection and is characterized by
colonic dilation, wall thickening, and surrounding inflammatory changes.
This patient is at great risk of perforation, and if it does not improve, it is usually treated
with a colectomy.