Toxic megacolon natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, toxic megacolon in patients with ulcerative colitis lead to death in 0.2% patients. Common complications of toxic megacolon include perforation, bleeding, shock, sepsis. Prognosis is generally good. | If left untreated, toxic megacolon in patients with [[ulcerative colitis]] lead to death in 0.2% patients. Common complications of toxic megacolon include [[perforation]], [[bleeding]], [[shock]], [[sepsis]]. [[Prognosis]] is generally good. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*If left untreated, toxic megacolon in patients with ulcerative colitis lead to death in 0.2% patients.<ref name="pmid11199366">{{cite journal |vauthors=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 |title=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) |journal=Scand. J. Gastroenterol. |volume=35 |issue=12 |pages=1272–7 |year=2000 |pmid=11199366 |doi= |url=}}</ref> | *If left untreated, toxic megacolon in patients with [[ulcerative colitis]] lead to death in 0.2% patients.<ref name="pmid11199366">{{cite journal |vauthors=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 |title=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) |journal=Scand. J. Gastroenterol. |volume=35 |issue=12 |pages=1272–7 |year=2000 |pmid=11199366 |doi= |url=}}</ref> | ||
*The following factors are associated with increased mortality:<ref name="pmid4008909">{{cite journal |vauthors=Greenstein AJ, Sachar DB, Gibas A, Schrag D, Heimann T, Janowitz HD, Aufses AH |title=Outcome of toxic dilatation in ulcerative and Crohn's colitis |journal=J. Clin. Gastroenterol. |volume=7 |issue=2 |pages=137–43 |year=1985 |pmid=4008909 |doi= |url=}}</ref><ref name="Sayedy2010">{{cite journal|last1=Sayedy|first1=Leena|title=Toxic megacolon associatedClostridium difficilecolitis|journal=World Journal of Gastrointestinal Endoscopy|volume=2|issue=8|year=2010|pages=293|issn=1948-5190|doi=10.4253/wjge.v2.i8.293}}</ref> | *The following factors are associated with increased [[mortality]]:<ref name="pmid4008909">{{cite journal |vauthors=Greenstein AJ, Sachar DB, Gibas A, Schrag D, Heimann T, Janowitz HD, Aufses AH |title=Outcome of toxic dilatation in ulcerative and Crohn's colitis |journal=J. Clin. Gastroenterol. |volume=7 |issue=2 |pages=137–43 |year=1985 |pmid=4008909 |doi= |url=}}</ref><ref name="Sayedy2010">{{cite journal|last1=Sayedy|first1=Leena|title=Toxic megacolon associatedClostridium difficilecolitis|journal=World Journal of Gastrointestinal Endoscopy|volume=2|issue=8|year=2010|pages=293|issn=1948-5190|doi=10.4253/wjge.v2.i8.293}}</ref> | ||
**Age>40 years | **Age>40 years | ||
**Female gender | **Female gender | ||
**Lower albumin level | **Lower [[albumin]] level | ||
**Lower serum CO2 | **Lower serum [[CO2]] | ||
**High BUN | **High [[BUN]] | ||
*The duration of inflammatory bowel disease do not affect mortality.<ref name="pmid7352781">{{cite journal |vauthors=Grieco MB, Bordan DL, Geiss AC, Beil AR |title=Toxic megacolon complicating Crohn's colitis |journal=Ann. Surg. |volume=191 |issue=1 |pages=75–80 |year=1980 |pmid=7352781 |pmc=1344622 |doi= |url=}}</ref><ref name="pmid6691535">{{cite journal |vauthors=Grant CS, Dozois RR |title=Toxic megacolon: ultimate fate of patients after successful medical management |journal=Am. J. Surg. |volume=147 |issue=1 |pages=106–10 |year=1984 |pmid=6691535 |doi= |url=}}</ref> | *The duration of [[inflammatory bowel disease]] do not affect [[mortality]].<ref name="pmid7352781">{{cite journal |vauthors=Grieco MB, Bordan DL, Geiss AC, Beil AR |title=Toxic megacolon complicating Crohn's colitis |journal=Ann. Surg. |volume=191 |issue=1 |pages=75–80 |year=1980 |pmid=7352781 |pmc=1344622 |doi= |url=}}</ref><ref name="pmid6691535">{{cite journal |vauthors=Grant CS, Dozois RR |title=Toxic megacolon: ultimate fate of patients after successful medical management |journal=Am. J. Surg. |volume=147 |issue=1 |pages=106–10 |year=1984 |pmid=6691535 |doi= |url=}}</ref> | ||
*There is recurrence rate of approximately 29% for patients of either toxic megacolon or fulminant colitis.<ref name="GanBeck2003">{{cite journal|last1=Gan|first1=S. Ian|last2=Beck|first2=P. L.|title=A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management|journal=The American Journal of Gastroenterology|volume=98|issue=11|year=2003|pages=2363–2371|issn=0002-9270|doi=10.1111/j.1572-0241.2003.07696.x}}</ref> | *There is recurrence rate of approximately 29% for patients of either toxic megacolon or fulminant colitis.<ref name="GanBeck2003">{{cite journal|last1=Gan|first1=S. Ian|last2=Beck|first2=P. L.|title=A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management|journal=The American Journal of Gastroenterology|volume=98|issue=11|year=2003|pages=2363–2371|issn=0002-9270|doi=10.1111/j.1572-0241.2003.07696.x}}</ref> | ||
===Complications=== | ===Complications=== | ||
*Common complications of toxic megacolon include:<ref name="Sayedy2010">{{cite journal|last1=Sayedy|first1=Leena|title=Toxic megacolon associatedClostridium difficilecolitis|journal=World Journal of Gastrointestinal Endoscopy|volume=2|issue=8|year=2010|pages=293|issn=1948-5190|doi=10.4253/wjge.v2.i8.293}}</ref><ref name="pmid22009735">{{cite journal |vauthors=Autenrieth DM, Baumgart DC |title=Toxic megacolon |journal=Inflamm. Bowel Dis. |volume=18 |issue=3 |pages=584–91 |year=2012 |pmid=22009735 |doi=10.1002/ibd.21847 |url=}}</ref> | *Common [[complications]] of toxic megacolon include:<ref name="Sayedy2010">{{cite journal|last1=Sayedy|first1=Leena|title=Toxic megacolon associatedClostridium difficilecolitis|journal=World Journal of Gastrointestinal Endoscopy|volume=2|issue=8|year=2010|pages=293|issn=1948-5190|doi=10.4253/wjge.v2.i8.293}}</ref><ref name="pmid22009735">{{cite journal |vauthors=Autenrieth DM, Baumgart DC |title=Toxic megacolon |journal=Inflamm. Bowel Dis. |volume=18 |issue=3 |pages=584–91 |year=2012 |pmid=22009735 |doi=10.1002/ibd.21847 |url=}}</ref> | ||
**Perforation or opening in the wall of the colon | **Perforation or opening in the wall of the colon | ||
**Bleeding | **[[Bleeding]] | ||
**Shock | **[[Shock]] | ||
**Sepsis | **[[Sepsis]] | ||
===Prognosis=== | ===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.<ref name="pmid6691535">{{cite journal |vauthors=Grant CS, Dozois RR |title=Toxic megacolon: ultimate fate of patients after successful medical management |journal=Am. J. Surg. |volume=147 |issue=1 |pages=106–10 |year=1984 |pmid=6691535 |doi= |url=}}</ref><ref name="pmid7555415">{{cite journal |vauthors=Trudel JL, Deschênes M, Mayrand S, Barkun AN |title=Toxic megacolon complicating pseudomembranous enterocolitis |journal=Dis. Colon Rectum |volume=38 |issue=10 |pages=1033–8 |year=1995 |pmid=7555415 |doi= |url=}}</ref> | *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]].<ref name="pmid6691535">{{cite journal |vauthors=Grant CS, Dozois RR |title=Toxic megacolon: ultimate fate of patients after successful medical management |journal=Am. J. Surg. |volume=147 |issue=1 |pages=106–10 |year=1984 |pmid=6691535 |doi= |url=}}</ref><ref name="pmid7555415">{{cite journal |vauthors=Trudel JL, Deschênes M, Mayrand S, Barkun AN |title=Toxic megacolon complicating pseudomembranous enterocolitis |journal=Dis. Colon Rectum |volume=38 |issue=10 |pages=1033–8 |year=1995 |pmid=7555415 |doi= |url=}}</ref> | ||
*Early surgical management leads to better prognosis when compared to medical management.<ref name="GanBeck2003">{{cite journal|last1=Gan|first1=S. Ian|last2=Beck|first2=P. L.|title=A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management|journal=The American Journal of Gastroenterology|volume=98|issue=11|year=2003|pages=2363–2371|issn=0002-9270|doi=10.1111/j.1572-0241.2003.07696.x}}</ref><ref name="pmid2493427">{{cite journal |vauthors=Danovitch SH |title=Fulminant colitis and toxic megacolon |journal=Gastroenterol. Clin. North Am. |volume=18 |issue=1 |pages=73–82 |year=1989 |pmid=2493427 |doi= |url=}}</ref> | *Early surgical management leads to better prognosis when compared to medical management.<ref name="GanBeck2003">{{cite journal|last1=Gan|first1=S. Ian|last2=Beck|first2=P. L.|title=A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management|journal=The American Journal of Gastroenterology|volume=98|issue=11|year=2003|pages=2363–2371|issn=0002-9270|doi=10.1111/j.1572-0241.2003.07696.x}}</ref><ref name="pmid2493427">{{cite journal |vauthors=Danovitch SH |title=Fulminant colitis and toxic megacolon |journal=Gastroenterol. Clin. North Am. |volume=18 |issue=1 |pages=73–82 |year=1989 |pmid=2493427 |doi= |url=}}</ref> | ||
*Majority of patients of toxic megacolon treated with medical management requires colectomy on long term follow up.<ref name="pmid4008909">{{cite journal |vauthors=Greenstein AJ, Sachar DB, Gibas A, Schrag D, Heimann T, Janowitz HD, Aufses AH |title=Outcome of toxic dilatation in ulcerative and Crohn's colitis |journal=J. Clin. Gastroenterol. |volume=7 |issue=2 |pages=137–43 |year=1985 |pmid=4008909 |doi= |url=}}</ref><ref name="pmid999345">{{cite journal |vauthors=Strauss RJ, Flint GW, Platt N, Levin L, Wise L |title=The surgical management of toxic dilatation of the colon: a report of 28 cases and review of the literature |journal=Ann. Surg. |volume=184 |issue=6 |pages=682–8 |year=1976 |pmid=999345 |pmc=1345407 |doi= |url=}}</ref> | *Majority of patients of toxic megacolon treated with medical management requires [[colectomy]] on long term follow up.<ref name="pmid4008909">{{cite journal |vauthors=Greenstein AJ, Sachar DB, Gibas A, Schrag D, Heimann T, Janowitz HD, Aufses AH |title=Outcome of toxic dilatation in ulcerative and Crohn's colitis |journal=J. Clin. Gastroenterol. |volume=7 |issue=2 |pages=137–43 |year=1985 |pmid=4008909 |doi= |url=}}</ref><ref name="pmid999345">{{cite journal |vauthors=Strauss RJ, Flint GW, Platt N, Levin L, Wise L |title=The surgical management of toxic dilatation of the colon: a report of 28 cases and review of the literature |journal=Ann. Surg. |volume=184 |issue=6 |pages=682–8 |year=1976 |pmid=999345 |pmc=1345407 |doi= |url=}}</ref> | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
If left untreated, toxic megacolon in patients with ulcerative colitis lead to death in 0.2% patients. Common complications of toxic megacolon include perforation, bleeding, shock, sepsis. Prognosis is generally good.
Natural History, Complications, and Prognosis
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]
- 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:[3][7]
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][9]
- Majority of patients of toxic megacolon treated with medical management requires colectomy on long term follow up.[2][10]
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.
- ↑ Danovitch SH (1989). "Fulminant colitis and toxic megacolon". Gastroenterol. Clin. North Am. 18 (1): 73–82. PMID 2493427.
- ↑ 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.