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Review

Toxic Megacolon: Background, Pathophysiology, Management Challenges and Solutions

, ORCID Icon, & ORCID Icon
Pages 203-210 | Published online: 19 May 2020

References

  • Bartram CI. Radiology in the current assessment of ulcerative colitis. Gastrointest Radiol. 1977;1(4):383–392. doi:10.1007/BF02256402
  • Lennard-Jones JE, Ritchie JK, Hilder W, Spicer CC. Assessment of severity in colitis: a preliminary study. Gut. 1975;16(8):579–584. doi:10.1136/gut.16.8.579
  • Ciccocioppo R, Corazza GR. In-hospital mortality for toxic megacolon. Intern Emerg Med. 2018;13(6):837–838. doi:10.1007/s11739-018-1919-6
  • Doshi R, Desai J, Shah Y, Decter D, Doshi S. Incidence, features, in-hospital outcomes and predictors of in-hospital mortality associated with toxic megacolon hospitalizations in the United States. Intern Emerg Med. 2018;13(6):881–887. doi:10.1007/s11739-018-1889-8
  • Autenrieth DM, Baumgart DC. Toxic megacolon. Inflamm Bowel Dis. 2012;18(3):584–591. doi:10.1002/ibd.21847
  • Ausch C, Madoff RD, Gnant M, et al. Aetiology and surgical management of toxic megacolon. Colorectal Dis. 2006;8(3):195–201. doi:10.1111/j.1463-1318.2005.00887.x
  • Grieco MB, Bordan DL, Geiss AC, Beil AR. Toxic megacolon complicating Crohn’s colitis. Ann Surg. 1980;191(1):75–80. doi:10.1097/00000658-198001000-00015
  • Greenstein AJ, Sachar DB, Gibas A, et al. Outcome of toxic dilatation in ulcerative and Crohn’s colitis. J Clin Gastroenterol. 1985;7(2):137–143. doi:10.1097/00004836-198504000-00007
  • Danovitch SH. Fulminant colitis and toxic megacolon. Gastroenterol Clin North Am. 1989;18(1):73–82.
  • Klipfel AA, Schein M, Fahoum B, Wise L. Acute abdomen and Clostridium difficile colitis: still a lethal combination. Dig Surg. 2000;17(2):160–163. doi:10.1159/000018821
  • Grundfest-Broniatowski S, Quader M, Alexander F, Walsh RM, Lavery I, Milsom J. Clostridium difficile colitis in the critically ill. Dis Colon Rectum. 1996;39(6):619–623. doi:10.1007/BF02056938
  • Jalan KN, Sircus W, Card WI, et al. An experience of ulcerative colitis. I. Toxic dilation in 55 cases. Gastroenterology. 1969;57(1):68–82. doi:10.1016/S0016-5085(19)33962-9
  • Bockus HL, Roth JL, Buchman E, et al. Life history of nonspecific ulcerative colitis: relation of prognosis to anatomical and clinical varieties. Gastroenterologia. 1956;86(5):549–581. doi:10.1159/000200623
  • Tomita R, Tanjoh K, Fujisaki S, Fukuzawa M. Peptidergic nerves in the colon of patients with ulcerative colitis. Hepatogastroenterology. 2000;47(32):400–404.
  • Tomita R, Tanjoh K. Role of nitric oxide in the colon of patients with ulcerative colitis. World J Surg. 1998;22(1):88–91; discussion 92. doi:10.1007/s002689900354
  • Pons L, Droy-Lefaix MT, Bueno L. Leukotriene D4 participates in colonic transit disturbances induced by intracolonic administration of trinitrobenzene sulfonic acid in rats. Gastroenterology. 1992;102(1):149–156. doi:10.1016/0016-5085(92)91794-5
  • Snape WJ, Kao HW. Role of inflammatory mediators in colonic smooth muscle function in ulcerative colitis. Dig Dis Sci. 1988;33(3 Suppl):65S–70S. doi:10.1007/BF01538133
  • Boeckxstaens GE, Pelckmans PA, Herman AG, Van Maercke YM. Involvement of nitric oxide in the inhibitory innervation of the human isolated colon. Gastroenterology. 1993;104(3):690–697. doi:10.1016/0016-5085(93)91003-Z
  • Palatka K, Serfozo Z, Vereb Z, et al. Changes in the expression and distribution of the inducible and endothelial nitric oxide synthase in mucosal biopsy specimens of inflammatory bowel disease. Scand J Gastroenterol. 2005;40(6):670–680. doi:10.1080/00365520510015539
  • Lundberg S, Holst M, Hellstrom PM. Expression of iNOS mRNA associated with suppression of colonic contraction in rat colitis. Acta Physiol (Oxf). 2006;187(4):489–494. doi:10.1111/j.1748-1716.2006.01576.x
  • Mourelle M, Casellas F, Guarner F, et al. Induction of nitric oxide synthase in colonic smooth muscle from patients with toxic megacolon. Gastroenterology. 1995;109(5):1497–1502. doi:10.1016/0016-5085(95)90636-3
  • Mourelle M, Vilaseca J, Guarner F, Salas A, Malagelada JR. Toxic dilatation of colon in a rat model of colitis is linked to an inducible form of nitric oxide synthase. Am J Physiol. 1996;270(3 Pt 1):G425–430. doi:10.1152/ajpgi.1996.270.3.G425
  • Schworer H, Bohn M, Waezsada SY, Raddatz D, Ramadori G. Successful treatment of megacolon associated with colitis with a nitric oxide synthase inhibitor. Am J Gastroenterol. 2001;96(7):2273–2274. doi:10.1111/j.1572-0241.2001.03986.x
  • Bockus HL, Roth JL, Buchman E, Kalser M, Staub WR,Finkelstein A and Valdes-Dapena ALife history of nonspecific ulcerative colitis: relation of prognosis to anatomical and clinical varieties. Gastroenterologia1956;86:549–581.26.
  • Gan SI, Beck PL. A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management. Am J Gastroenterol. 2003;98(11):2363–2371. doi:10.1111/j.1572-0241.2003.07696.x
  • Maddu KK, Mittal P, Shuaib W, Tewari A, Ibraheem O, Khosa F. Colorectal emergencies and related complications: a comprehensive imaging review–imaging of colitis and complications. AJR Am J Roentgenol. 2014;203(6):1205–1216. doi:10.2214/AJR.13.12250
  • Skomorochow E, Pico J. Toxic Megacolon. Treasure Island (FL): StatPearls; 2020.
  • Hommes DW, Sterringa G, van Deventer SJ, Tytgat GN, Weel J. The pathogenicity of cytomegalovirus in inflammatory bowel disease: a systematic review and evidence-based recommendations for future research. Inflamm Bowel Dis. 2004;10(3):245–250. doi:10.1097/00054725-200405000-00011
  • Hartong WA, Arvanitakis C, Skibba RM, Klotz AP. Treatment of toxic megacolon. A comparative review of 29 patients. Am J Dig Dis. 1977;22(3):195–200. doi:10.1007/BF01072276
  • Roys G, Kaplan MS, Juler GL. Surgical management of toxic megacolon. Am J Gastroenterol. 1977;68(2):161–166.
  • Trudel JL, Deschenes M, Mayrand S, Barkun AN. Toxic megacolon complicating pseudomembranous enterocolitis. Dis Colon Rectum. 1995;38(10):1033–1038. doi:10.1007/BF02133974
  • Greenstein AJ, Aufses AH. Differences in pathogenesis, incidence and outcome of perforation in inflammatory bowel disease. Surg Gynecol Obstet. 1985;160(1):63–69.
  • Greenstein AJ, Barth JA, Sachar DB, Aufses AH. Free colonic perforation without dilatation in ulcerative colitis. Am J Surg. 1986;152(3):272–275. doi:10.1016/0002-9610(86)90256-4
  • Alemayehu G, Jarnerot G. Colonoscopy during an attack of severe ulcerative colitis is a safe procedure and of great value in clinical decision making. Am J Gastroenterol. 1991;86(2):187–190.
  • Dickinson RJ, Ashton MG, Axon AT, Smith RC, Yeung CK, Hill GL. Controlled trial of intravenous hyperalimentation and total bowel rest as an adjunct to the routine therapy of acute colitis. Gastroenterology. 1980;79(6):1199–1204. doi:10.1016/0016-5085(80)90913-0
  • Norland CC, Kirsner JB. Toxic dilatation of colon (toxic megacolon): etiology, treatment and prognosis in 42 patients. Medicine (Baltimore). 1969;48(3):229–250. doi:10.1097/00005792-196905000-00003
  • Travis SP, Stange EF, Lemann M, et al. European evidence-based Consensus on the management of ulcerative colitis: current management. J Crohns Colitis. 2008;2(1):24–62.
  • Kornbluth A, Sachar DB. Practice parameters committee of the American college of G. Ulcerative colitis practice guidelines in adults: American college of gastroenterology, practice parameters committee. Am J Gastroenterol. 2010;105(3):501–523; quiz 524. doi:10.1038/ajg.2009.727
  • Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994;330(26):1841–1845. doi:10.1056/NEJM199406303302601
  • Kohn A, Daperno M, Armuzzi A, et al. Infliximab in severe ulcerative colitis: short-term results of different infusion regimens and long-term follow-up. Aliment Pharmacol Ther. 2007;26(5):747–756. doi:10.1111/j.1365-2036.2007.03415.x
  • Panos MZ, Wood MJ, Asquith P. Toxic megacolon: the knee-elbow position relieves bowel distension. Gut. 1993;34(12):1726–1727. doi:10.1136/gut.34.12.1726
  • Grant CS, Dozois RR. Toxic megacolon: ultimate fate of patients after successful medical management. Am J Surg. 1984;147(1):106–110. doi:10.1016/0002-9610(84)90042-4
  • Neal MD, Alverdy JC, Hall DE, Simmons RL, Zuckerbraun BS. Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease. Ann Surg. 2011;254(3):423–429. doi:10.1097/SLA.0b013e31822ade48
  • Sawada K, Egashira A, Ohnishi K, Fukunaga K, Kusaka T, Shimoyama T. Leukocytapheresis (LCAP) for management of fulminant ulcerative colitis with toxic megacolon. Dig Dis Sci. 2005;50(4):767–773. doi:10.1007/s10620-005-2571-3
  • Shetler K, Nieuwenhuis R, Wren SM, Triadafilopoulos G. Decompressive colonoscopy with intracolonic vancomycin administration for the treatment of severe pseudomembranous colitis. Surg Endosc. 2001;15(7):653–659. doi:10.1007/s004640080104
  • Knroki K, Masuda A, Uehara H, Kuroki A. A new treatment for toxic megacolon. Lancet. 1998;352(9130):782. doi:10.1016/S0140-6736(98)95043-7
  • Pascu M, Muller AR, Wiedenmann B, Dignass AU. Rescue therapy with tacrolimus in a patient with toxic megacolon. Int J Colorectal Dis. 2003;18(3):271–275. doi:10.1007/s00384-002-0458-8
  • Shah PJ, Vakil N, Kabakov A. Role of intravenous immune globulin in streptococcal toxic shock syndrome and Clostridium difficile infection. Am J Health Syst Pharm. 2015;72(12):1013–1019. doi:10.2146/ajhp140359
  • Beaugerie L, Ngo Y, Goujard F, et al. Etiology and management of toxic megacolon in patients with human immunodeficiency virus infection. Gastroenterology. 1994;107(3):858–863. doi:10.1016/0016-5085(94)90137-6
  • Davidson T, Allen-Mersh TG, Miles AJ, et al. Emergency laparotomy in patients with AIDS. Br J Surg. 1991;78(8):924–926. doi:10.1002/bjs.1800780809
  • Quddus A, Martin-Perez B, Schoonyoung H, Albert M, Atallah S. Toxic megacolon during pregnancy in ulcerative colitis: a case report. Int J Surg Case Rep. 2015;11:83–86. doi:10.1016/j.ijscr.2015.04.033
  • Truelove SC, Willoughby CP, Lee EG, Kettlewell MG. Further experience in the treatment of severe attacks of ulcerative colitis. Lancet. 1978;2(8099):1086–1088. doi:10.1016/S0140-6736(78)91816-0
  • Anderson JB, Turner GM, Williamson RC. Fulminant ulcerative colitis in late pregnancy and the puerperium. J R Soc Med. 1987;80(8):492–494. doi:10.1177/014107688708000812
  • Boulton R, Hamilton M, Lewis A, Walker P, Pounder R. Fulminant ulcerative colitis in pregnancy. Am J Gastroenterol. 1994;89(6):931–933.
  • Strauss RJ, Flint GW, Platt N, Levin L, Wise L. The surgical management of toxic dilatation of the colon: a report of 28 cases and review of the literature. Ann Surg. 1976;184(6):682–688. doi:10.1097/00000658-197612000-00004
  • Snowden JA, Young MJ, McKendrick MW. Dilatation of the colon complicating acute self-limited colitis. Q J Med. 1994;87(1):55–62.
  • Rubin MS, Bodenstein LE, Kent KC. Severe Clostridium difficile colitis. Dis Colon Rectum. 1995;38(4):350–354. doi:10.1007/BF02054220
  • Greenstein AJ, Kark AE, Dreiling DA. Crohn’s disease of the colon. III. Toxic dilatation of the colon in Crohn’s colitis. Am J Gastroenterol. 1975;63(2):117–128.
  • Flatmark A, Fretheim B, Gjone E. Early colectomy in severe ulcerative colitis. Scand J Gastroenterol. 1975;10(4):427–431.