Toxic megacolon surgery: Difference between revisions
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*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> | *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 | **Failed medical therapy | ||
**Progressive toxicity or dilation | **Progressive toxicity or [[dilation]] | ||
**Signs of perforation | **Signs of [[perforation]] | ||
{| | {| | ||
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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]] | ||
Revision as of 19:12, 17 November 2017
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Toxic Megacolon Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Toxic megacolon surgery On the Web |
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American Roentgen Ray Society Images of Toxic megacolon surgery |
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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:
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.