Toxic megacolon surgery
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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]
- 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:[2][3]
- 1.Total or subtotal colectomy and ileostomy with
- 1.1.Hartmann 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 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.
- ↑ 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.