Toxic megacolon surgery: Difference between revisions
Farima Kahe (talk | contribs) |
Farima Kahe (talk | contribs) |
||
Line 26: | Line 26: | ||
**Progressive toxicity or dilation | **Progressive toxicity or dilation | ||
**Signs of perforation | **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;" + |Pnemuoperitoneum | | style="background:#F5F5F5;" + |Pnemuoperitoneum | ||
|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 24–48 h | | 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== | ==Surgery== | ||
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> | 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. Total or subtotal colectomy and ileostomy with''' | ||
**1.1. Hartmann pouch | **1.1. Hartmann pouch | ||
**1.2. Mucous fistula | **1.2. [[Mucous]] [[fistula]] | ||
**1.3. Subcutaneous exteriorization of closed distal bowel | **1.3. Subcutaneous exteriorization of closed distal bowel | ||
*2. Total proctocolectomy and ileostomy | *'''2. Total proctocolectomy and ileostomy''' | ||
*3. Diversion procedures | *'''3. Diversion procedures''' | ||
**3.1. Ileostomy | **3.1. [[Ileostomy]] | ||
**3.2. Cecostomy | **3.2. [[Cecostomy]] | ||
**3.3. Ileostomy with transverse decompressive colostomy (Turnbull “blowhole” procedure) | **3.3. [[Ileostomy]] with transverse decompressive [[colostomy]] (Turnbull “blowhole” procedure) | ||
*4. Restorative procedures | *'''4. Restorative procedures''' | ||
**4.1. Total colectomy and ileorectal anastomosis | **4.1. Total [[colectomy]] and ileorectal [[anastomosis]] | ||
**4.2. Restorative proctocolectomy with ileal pouch–anal anastomosis | **4.2. Restorative [[proctocolectomy]] with ileal pouch–anal [[anastomosis]] | ||
==References== | ==References== |
Revision as of 19:14, 8 November 2017
Toxic Megacolon Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Toxic megacolon surgery On the Web |
American Roentgen Ray Society Images of Toxic megacolon surgery |
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:
Overview
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
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 |
Pnemuoperitoneum | 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
Surgery methods of toxic megacolon include:[3][4][5]
- 1. Total or subtotal colectomy and ileostomy with
- 2. Total proctocolectomy and ileostomy
- 3. Diversion procedures
- 4. Restorative procedures
- 4.1. Total colectomy and ileorectal 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.