Disease class: Megacolon
Definition
Causes
- Inflammatory bowel disease
- Clostridium difficile colitis
Complications
- Colonic rupture
- Bacteraemia
- Sepsis
- Septic shock
Investigations
- Abdominal radiograph (AXR)
- CT scan of abdomen and pelvis with bowel contrast (if possible)
Diagnostic tips
- Faecal loading can cause small areas of dilatation.
- It is normal for some segments of bowel to have a relatively large diameter. The "369 rule" refers to the approximate normal diameters of small bowel (up to 3cm), large bowel (up to 6cm), caecum + sigmoid colon (up to 9cm).
- If the clinical history and physical examination support a diagnosis of toxic megacolon and the AXR may show abnormal dilation, it is worth discussing the AXR with a specialist colleague.
- If there is a strong suspicion of toxic megacolon, inform senior colleagues, request an arterial blood gas analysis, request an urgent abdominal radiograph (if not done already) and seek specialist advice immediately.
Treatment
Depends on severity and underlying cause
Conservative
- Watchful waiting
Medical
- Antibiotic therapy
- Clostridium difficile eradication therapy (e.g. oral vancomycin)
Surgical
- Pancolectomy
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