Toxic megacolon surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Toxic megacolon}} | {{Toxic megacolon}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{F.K}} | ||
==Overview== | ==Overview== | ||
The mainstay of treatment for toxic megacolon is medical therapy. [[Surgery]] is usually reserved for patients with either failed medical therapy, progressive [[toxicity]] or [[dilation]] and signs of [[perforation]]. | |||
The mainstay of treatment for | |||
==Indications== | |||
*The mainstay of treatment for toxic megacolon is medical therapy. [[Surgery]] is usually reserved for patients with:<ref>{{cite book | last = Fischer | first = Josef | title = Mastery of surgery | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2007 | isbn = 9780781771658 }}</ref><ref name="pmid3781329">{{cite journal |vauthors=Bolton RP, Culshaw MA |title=Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile |journal=Gut |volume=27 |issue=10 |pages=1169–72 |year=1986 |pmid=3781329 |pmc=1433873 |doi= |url=}}</ref> | |||
**Failed medical therapy | |||
**Progressive toxicity or [[dilation]] | |||
**Signs of [[perforation]] | |||
{| | {| | ||
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Indications for surgery | ! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Indications for surgery | ||
|- | |- | ||
!style="background:#4479BA; color: #FFFFFF;" align="center" + |Absolute | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Absolute | ||
!style="background:#4479BA; color: #FFFFFF;" align="center" + |Relative | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Relative | ||
|- | |- | ||
|style="background:#F5F5F5;" + | | | style="background:#F5F5F5;" + |Pnemuo-[[peritoneum]] | ||
|style="background:#F5F5F5;" + |Inability to promptly control sepsis | | style="background:#F5F5F5;" + |Inability to promptly control [[sepsis]] | ||
|- | |- | ||
|style="background:#F5F5F5;" + |Diffuse peritonitis | | style="background:#F5F5F5;" + |Diffuse [[peritonitis]] | ||
|style="background:#F5F5F5;" + |Increasing megacolon | | style="background:#F5F5F5;" + |Increasing megacolon | ||
|- | |- | ||
|style="background:#F5F5F5;" + |Localized peritonitis with increasing abdominal pain and/or colonic distension >10 cm | | style="background:#F5F5F5;" + |Localized [[peritonitis]] with increasing [[abdominal pain]] and/or colonic distension >10 cm | ||
|style="background:#F5F5F5;" + |Failure to improve within | | style="background:#F5F5F5;" + |Failure to improve within 24-48 h | ||
|- | |- | ||
|style="background:#F5F5F5;" + |Uncontrolled sepsis | | style="background:#F5F5F5;" + |Uncontrolled [[sepsis]] | ||
|style="background:#F5F5F5;" + |Increasing toxicity or other signs of clinical deterioration | | style="background:#F5F5F5;" + |Increasing toxicity or other signs of clinical deterioration | ||
|- | |- | ||
|style="background:#F5F5F5;" + |Major hemorrhage | | style="background:#F5F5F5;" + |Major [[hemorrhage]] | ||
|style="background:#F5F5F5;" + |Continued transfusion requirements | | style="background:#F5F5F5;" + |Continued transfusion requirements | ||
|} | |} | ||
== | ==Surgery== | ||
{| align="right" | |||
| {{#ev:youtube|_CTC8L34w6m0|500}} | |||
|} | |||
Surgery methods of toxic megacolon include:<ref name="pmid28097034">{{cite journal |vauthors=Kerstens J, Diebels I, de Gheldere C, Vanclooster P |title=Blowhole Colostomy for Clostridium difficile-Associated Toxic Megacolon |journal=Case Rep Surg |volume=2016 |issue= |pages=5909248 |year=2016 |pmid=28097034 |pmc=5209592 |doi=10.1155/2016/5909248 |url=}}</ref><ref name="pmid16466559">{{cite journal |vauthors=Ausch C, Madoff RD, Gnant M, Rosen HR, Garcia-Aguilar J, Hölbling N, Herbst F, Buxhofer V, Holzer B, Rothenberger DA, Schiessel R |title=Aetiology and surgical management of toxic megacolon |journal=Colorectal Dis |volume=8 |issue=3 |pages=195–201 |year=2006 |pmid=16466559 |doi=10.1111/j.1463-1318.2005.00887.x |url=}}</ref><ref name="Arnell2004">{{cite journal|last1=Arnell|first1=Tracey|title=Surgical Management of Acute Colitis and Toxic Megacolon|journal=Clinics in Colon and Rectal Surgery|volume=17|issue=01|year=2004|pages=71–74|issn=1531-0043|doi=10.1055/s-2004-823073}}</ref> | |||
*'''1. Total or subtotal [[colectomy]] and [[ileostomy]] with''' | |||
**1.1. [[Hartmann's pouch]] | |||
**1.2. [[Mucous]] [[fistula]] | |||
**1.3. Subcutaneous exteriorization of closed distal bowel | |||
*'''2. Total [[proctocolectomy]] and [[ileostomy]]''' | |||
*'''3. Diversion procedures''' | |||
**3.1. [[Ileostomy]] | |||
**3.2. Cecostomy | |||
**3.3. [[Ileostomy]] with transverse decompressive [[colostomy]] (Turnbull “blowhole” procedure) | |||
*'''4. Restorative procedures''' | |||
**4.1. Total [[colectomy]] and ileo-rectal [[anastomosis]] | |||
**4.2. Restorative [[proctocolectomy]] with ileal pouch–anal [[anastomosis]] | |||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category: | [[Category:Radiology]] | ||
[[Category:Surgery]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] |
Latest revision as of 18:51, 8 December 2017
Toxic Megacolon Microchapters |
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Toxic megacolon surgery On the Web |
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Risk calculators and risk factors for Toxic megacolon surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
The mainstay of treatment for toxic megacolon is medical therapy. Surgery is usually reserved for patients with either failed medical therapy, progressive toxicity or dilation and signs of perforation.
Indications
- The mainstay of treatment for toxic megacolon is medical therapy. Surgery is usually reserved for patients with:[1][2]
- Failed medical therapy
- Progressive toxicity or dilation
- Signs of perforation
Indications for surgery | |
---|---|
Absolute | Relative |
Pnemuo-peritoneum | Inability to promptly control sepsis |
Diffuse peritonitis | Increasing megacolon |
Localized peritonitis with increasing abdominal pain and/or colonic distension >10 cm | Failure to improve within 24-48 h |
Uncontrolled sepsis | Increasing toxicity or other signs of clinical deterioration |
Major hemorrhage | Continued transfusion requirements |
Surgery
_CTC8L34w6m0|500}} |
Surgery methods of toxic megacolon include:[3][4][5]
- 1. Total or subtotal colectomy and ileostomy with
- 1.1. Hartmann's pouch
- 1.2. Mucous fistula
- 1.3. Subcutaneous exteriorization of closed distal bowel
- 2. Total proctocolectomy and ileostomy
- 3. Diversion procedures
- 4. Restorative procedures
- 4.1. Total colectomy and ileo-rectal anastomosis
- 4.2. Restorative proctocolectomy with ileal pouch–anal anastomosis
References
- ↑ Fischer, Josef (2007). Mastery of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9780781771658.
- ↑ Bolton RP, Culshaw MA (1986). "Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile". Gut. 27 (10): 1169–72. PMC 1433873. PMID 3781329.
- ↑ Kerstens J, Diebels I, de Gheldere C, Vanclooster P (2016). "Blowhole Colostomy for Clostridium difficile-Associated Toxic Megacolon". Case Rep Surg. 2016: 5909248. doi:10.1155/2016/5909248. PMC 5209592. PMID 28097034.
- ↑ Ausch C, Madoff RD, Gnant M, Rosen HR, Garcia-Aguilar J, Hölbling N, Herbst F, Buxhofer V, Holzer B, Rothenberger DA, Schiessel R (2006). "Aetiology and surgical management of toxic megacolon". Colorectal Dis. 8 (3): 195–201. doi:10.1111/j.1463-1318.2005.00887.x. PMID 16466559.
- ↑ Arnell, Tracey (2004). "Surgical Management of Acute Colitis and Toxic Megacolon". Clinics in Colon and Rectal Surgery. 17 (01): 71–74. doi:10.1055/s-2004-823073. ISSN 1531-0043.