Toxic Megacolon

An acute form of MEGACOLON, severe pathological dilatation of the COLON. It is associated with clinical conditions such as ULCERATIVE COLITIS; CROHN DISEASE; AMEBIC DYSENTERY; or CLOSTRIDIUM ENTEROCOLITIS.

Also Known As:

Networked: 165 relevant articles (10 outcomes, 3 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Ulcerative Colitis
2.	Pseudomembranous Enterocolitis (Pseudomembranous Colitis)
3.	Crohn Disease (Crohn's Disease)
4.	Inflammatory Bowel Diseases (Inflammatory Bowel Disease)
5.	Ileus

Experts

1.	Remzi, Feza H: 4 articles (02/2015 - 07/2003)
2.	Turner, Dan: 3 articles (08/2012 - 01/2009)
3.	Shen, Bo: 2 articles (02/2015 - 06/2013)
4.	Larrauri, J: 2 articles (04/2011 - 01/2010)
5.	Tovar, J A: 2 articles (04/2011 - 01/2010)
6.	Prieto, G: 2 articles (04/2011 - 01/2010)
7.	Barrena, S: 2 articles (04/2011 - 01/2010)
8.	Lassaletta, L: 2 articles (04/2011 - 01/2010)
9.	Martínez, L: 2 articles (04/2011 - 01/2010)
10.	Cadarette, Suzanne M: 1 article (12/2015)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Toxic Megacolon:

1.	VancomycinFDA LinkGeneric 02/18/1984 - "The symptoms of many infants with toxin settled spontaneously, but one child became acutely and severely ill and developed a toxic megacolon and five others required, and responded to, vancomycin. " 01/01/1992 - "Despite specific oral treatment (against Clostridium difficile) by vancomycin, toxic megacolon required urgent subtotal colectomy with ileostomy and sigmoidostomy. " 07/01/2004 - "Colostomy with vancomycin administration as an effective treatment for toxic megacolon associated with fulminant pseudomembranous colitis: a case report." 07/01/2001 - "We explored the potential of early decompressive colonoscopy with intracolonic vancomycin administration as an adjunctive therapy for severe pseudomembranous Clostridium difficile colitis with ileus and toxic megacolon. " 07/01/2001 - "Colonoscopic decompression and intracolonic vancomycin administration in the management of severe, acute, pseudomembranous colitis associated with ileus and toxic megacolon is feasible, safe, and effective in approximately 57% to 71% of cases."
2.	infliximab (Remicade)FDA Link 12/01/2013 - "We report two cases of steroid and antibiotic-refractory fulminant Crohn's colitis, complicated by toxic megacolon, who were successfully treated with infliximab (IFX), thus avoiding surgical intervention. " 04/01/2012 - "This is the first report of treatment of Crohn disease-associated toxic megacolon with infliximab." 04/01/2012 - "Infliximab in Crohn's disease-associated toxic megacolon." 07/01/2007 - "[Severe ulcerative colitis, with toxic megacolon, resolved with infliximab therapy]." 01/01/2004 - "Infliximab in the treatment of ulcerative colitis with toxic megacolon."
3.	Tacrolimus (Prograf)FDA LinkGeneric 05/01/2003 - "Rescue therapy with tacrolimus in a patient with toxic megacolon." 05/01/2003 - "We report an unusual case of fulminant steroid-refractory ulcerative colitis complicated by toxic megacolon treated successfully with the immunosuppressant tacrolimus. " 08/01/2015 - "In steroid-refractory UC, early intensive therapy using anti-tumor necrosis factor (TNF) antibodies or the calcineurin inhibitors cyclosporine and tacrolimus is indicated in any case to prevent progression to a toxic megacolon and/or to avoid proctocolectomy. "
4.	Prednisolone (Predate)FDA LinkGeneric 12/01/2007 - "One patient had life-threatening symptoms (toxic megacolon, pneumonitis, disseminated intravascular coagulation) despite high-dose prednisolone. " 10/01/1997 - "Intensive intravenous prednisolone therapy with total parenteral nutrition was dramatically effective in treating the toxic megacolon and inducing remission in Crohn's disease and afterward, remission of the nephrotic syndrome. "
5.	Morphine (MS Contin)FDA LinkGeneric 11/01/2006 - "We have demonstrated the safe and effective use of ketamine analgesia in children with toxic megacolon, a condition in which the child is in severe pain and morphine is contraindicated."
6.	KetamineFDA LinkGeneric 11/01/2006 - "We have demonstrated the safe and effective use of ketamine analgesia in children with toxic megacolon, a condition in which the child is in severe pain and morphine is contraindicated."
7.	Nitric Oxide (Nitrogen Monoxide)FDA Link 08/01/1998 - "Clinical studies have shown that nitric oxide is elevated in several inflammatory bowel diseases and other secretory conditions including ulcerative colitis, Crohn's disease, toxic megacolon, diverticulitis, infectious gastroenteritis, and infantile methemoglobinemia. "
8.	SteroidsIBA 04/01/1979 - "Steroids and toxic megacolon." 10/01/1978 - "The place of steroids in the therapy of toxic megacolon." 01/01/2014 - "Intravenous steroids are often recommended for patients with toxic megacolon secondary to ulcerative colitis. " 02/01/2010 - "Mortality was significantly (p<0.05) associated with a higher APACHE II score, a higher ASA class, a lower diastolic blood pressure, preexisting pulmonary and renal disease, use of steroids, evidence of toxic megacolon, higher WBCs, and clinical signs of sepsis and organ dysfunction (renal and pulmonary). " 07/01/2002 - "Toxic megacolon is treated aggressively, initially medically, with high-dose steroids and attention to fluid balance, ulcerative colitis being the usual working diagnosis. "
9.	Anti-Bacterial Agents (Antibiotics)IBA 08/01/2000 - "The presence of toxic megacolon due to Clostridium difficile in patients with ulcerative colitis is a rare complication that may be suspected in patients with initial relapse who are on antibiotics." 01/01/2000 - "The clinical course of these two cases suggests that toxic megacolon is a severe complication of salmonellosis in children, irrespective of the use of antibiotics. " 11/01/1998 - "Although he had only been treated with topical antibiotics, he developed Clostridium difficile colitis after his second surgery that progressed to Toxic Megacolon and perforation. " 01/01/2000 - "In addition to maximal medical therapy as for severe colitis including broad spectrum antibiotics, patients with toxic megacolon should be kept nil per os, with small bowel decompression tube (if a small bowel ileus is present) and rotated into the prone or knee-elbow position frequently (evacuation of bowel gas). " 05/01/1996 - "After being treated for pneumonia with antibiotics, an 82-year-old man with a history of colonic carcinoma developed pseudomembranous colitis with toxic megacolon. "
10.	Loperamide (Imodium)FDA LinkGeneric 01/01/1993 - "[Toxic megacolon caused by loperamide-myorelaxants combination]." 01/01/2007 - "Loperamide and other anti-motility agents have been implicated previously in the pathogenesis of toxic megacolon in patients with infectious gastroenteritis." 03/01/1994 - "[Toxic megacolon caused by loperamide as initial form of Crohn disease]." 07/01/1990 - "Loperamide related toxic megacolon in Clostridium difficile colitis." 04/01/2000 - "Even in usually harmless enterocolitis like campylobacter infection, predisposing factors such as loperamide are known to precipitate toxic megacolon and should be considered in clinical practice."

Therapies and Procedures

1.	Decompression 10/01/1988 - "Most reports on the management of toxic megacolon stress the need for early surgical intervention, but our success in decompression with the addition of the "rolling technique" suggests an improvement in the nonoperative management of toxic megacolon." 01/01/1989 - "Endoscopic decompression in "toxic megacolon"." 10/01/1988 - "Medical decompression of toxic megacolon by "rolling". " 09/01/1988 - "This method of decompression has allowed us to perform colonic resection in all patients with toxic megacolon seen in recent years. " 07/01/1987 - "Endoscopic colonic decompression of toxic megacolon, placement of colonic tube, and steroid colonclysis."
2.	Ileostomy 04/01/1977 - "Total proctocolectomy and ileostomy: procedure of choice for acute toxic megacolon." 08/26/2013 - "A computed tomography revealed that the colon was dilated to a diameter of 17 cm. Based on a diagnosis of toxic megacolon, a subtotal colectomy and an ileostomy were carried out. " 12/01/2012 - "Subtotal colectomy with ileostomy remains the standard of care when toxic megacolon, perforation, or an acute surgical abdomen is present, but mortality rates are high. " 03/01/2007 - "He was found to have toxic megacolon on plain X-ray and subsequently underwent total colectomy and ileostomy. " 07/01/2003 - "The blow-hole colostomy-ileostomy procedure is still indicated for select patients with toxic megacolon and large-bowel obstruction. "
3.	Colostomy 09/01/1988 - "We have not resorted to blowhole colostomies in cases of toxic megacolon, as this leaves the colon, which is the septic source, within the abdominal cavity. " 07/01/2003 - "The blow-hole colostomy-ileostomy procedure is still indicated for select patients with toxic megacolon and large-bowel obstruction. " 05/01/1980 - "On the seventh postoperative day, toxic megacolon complicated the disease and a diverting ileostomy with decompression colostomies was performed. " 07/01/2003 - "Because of improved medical care and surgical techniques blow-hole colostomy with loop ileostomy is now rarely performed to reduce operative risks in patients with toxic megacolon related to inflammatory bowel disease (IBD). " 07/01/2004 - "Colostomy with vancomycin administration as an effective treatment for toxic megacolon associated with fulminant pseudomembranous colitis: a case report."
4.	Colectomy 08/01/2011 - "difficile-related toxic megacolon and post-operative outcomes of total colectomy should be investigated in a larger observational study." 12/15/2015 - "cCDI was defined as 1 or more of the following: colonic perforation, toxic megacolon, colectomy, admission to an intensive care unit for cCDI, or if CDI contributed to death within 30 days of enrollment. " 05/01/2014 - "Toxic megacolon carries still a substantial mortality and the decision when to per form emergent colectomy needs precise predictors outcome. " 01/01/2014 - "Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon) should be considered for colectomy. " 01/01/2014 - "We describe the case of a young woman who presented as an acute surgical emergency, diagnosed as toxic megacolon necessitating an emergency total colectomy. "
5.	Total Parenteral Nutrition 10/01/1997 - "Intensive intravenous prednisolone therapy with total parenteral nutrition was dramatically effective in treating the toxic megacolon and inducing remission in Crohn's disease and afterward, remission of the nephrotic syndrome. " 11/01/1988 - "A patient operated for toxic megacolon secondary to ulcerative colitis developed a Wernicke syndrome (thiamine deficiency) during the postoperative period despite the administration of the usually recommended doses of vitamin B1 during total parenteral nutrition (TPN) treatment. " 10/11/2001 - "Conservative treatment of toxic megacolon consists of water and electrolyte replacement, total parenteral nutrition, administration of corticosteroids and broad-spectrum antibiotics and repeat patient's prone positioning. "