China
Africa
Explore chapters and articles related to this topic
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
The abdominal x-ray shows a dilated transverse colon measuring 9 cm. His WCC is 18. What is the diagnosis?Acute colitis is diagnosed using Truelove and Witt's criteria (more than six bloody stools, Hb < 10.5, ESR > 30, temp > 37.8°C, HR > 90).Toxic megacolon is diagnosed if there is: >6 cm transverse colonic dilatationAny three of fever, tachycardia, leucocytosis, anaemiaAny one of dehydration, altered mental status, electrolyte abnormality or hypotensionThe microscopic hallmark is inflammation extending beyond the mucosa.
Toxic Megacolon in Crohn’s Colitis
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Toxic megacolon is a condition traditionally characterized by gross colonic distension in the setting of severe colitis culminating in septic shock. It may occur as a consequence of either inflammatory bowel disease (more so in ulcerative colitis than Crohn’s disease) or infective colitis (e.g. cytomegalovirus or Clostridium difficile) characterized by gross segmental or pancolonic distension greater than 6 cm [1]. The muco-submucosal barrier is lost with severe pancolonic inflammation resulting in colonic dysmotility, colonic dilation, fecal stasis, and bacterial translocation. This functional obstruction runs the risk of a megacolon and perforation of a thin-walled ascending colon and cecum. Often in pancolitis, diarrhea, with or without blood, prevails. Septic shock in colitis may not necessarily be accompanied by a megacolon. Hence, we tend to use the term “toxic colitis” to describe the condition of severe colitis causing shock, despite maximal antibiotic and anti-inflammatory treatment. Toxicity and the entity of a megacolon may exist independent of each other.
The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
Most children with acute colitis do not require intensive imaging. The plain film may show a generalized absence of faecal residue, with a variable bowel gas pattern. Severe bowel wall thickening may be evident as ‘thumb-printing’, due to severe swelling of the normally thin colonic haustra. Toxic megacolon occurs if there is marked dilatation of the diseased colon. This requires careful X-ray follow-up, as there is significant risk of perforation if the colon is markedly distended.
Fecal microbiota transplantation: a review on current formulations in Clostridioides difficile infection and future outlooks
Published in Expert Opinion on Biological Therapy, 2022
Adèle Rakotonirina, Tatiana Galperine, Eric Allémann
Symptoms of CDI appear when C. difficile secretes exotoxins that will disturb the epithelial cell cytoskeleton. This disruption leads to intestinal cell apoptosis and an inflammatory response, which then leads to disease manifestation. The main symptom is abundant diarrhea, defined as more than three liquid (Bristol 6–7) stools lost per day. However, the disease could lead to more severe symptoms, such as hemodynamic instability, signs and symptoms of peritonitis, signs and symptoms of colonic ileus, colon distension, colonic wall thickening, pseudomembranous colitis or even toxic megacolon [19,20]. Thus, all forms of CDIs place a heavy burden on health care economics [21]. Furthermore, CDI patients have a higher mortality rate than non-CDI patients with the same comorbidity factors [22].
Clinical management of severe, fulminant, and refractory Clostridioides difficile infection
Published in Expert Review of Anti-infective Therapy, 2020
In a retrospective cohort study by Hocquart and colleagues, patients admitted for CDI were compared based on therapy [96]. Among the roughly 60% of patients with SCDI in the study, 3-month mortality was 12.1% in patients receiving FMT within 2–4 days of diagnosis and 42.2% among those who received standard anti-CDI therapy (p < 0.0001). No patients in this cohort underwent surgery and the authors concluded that just two patients with SCDI would need FMT to save one life. These results were replicated at 3 other centers including the Mount Sinai Hospital [97], Gemelli Hospital [95], and Indiana University [94]. All reports showed decreased mortality in hospitalized patients with severe and fulminant CDI receiving FMT. In most cases, multiple or sequential FMTs were needed in combination with anti-CDI antibiotics such as vancomycin or fidaxomicin per a previously published pseudomembrane-driven colonoscopic FMT protocol [89]. FMT can be safely administered via careful colonoscopy even in patients with toxic megacolon, often leading to rapid and dramatic improvement in clinical symptoms. Screened and frozen stool-derived microbiota is now available from several stool bank allowing for prompt treatment of such patients.
Paediatric inflammatory bowel disease: review with a focus on practice in low- to middle-income countries
Published in Paediatrics and International Child Health, 2019
Anthony Mark Dalzell, Muhammad Eyad Ba’Ath
In UC, unresponsiveness to intravenous steroid therapy, anaemia and the need for blood transfusion are major predictors of colectomy [81]. In some studies, the rectal sparing type has been identified as an independent risk factor for urgent/emergent surgery in surgically treated patients with UC [82]. Acute indications include toxic megacolon which is rare in children. Surgical options in UC include total or subtotal colectomy with ileorectal anastomosis and subsequent lifelong surveillance of the rectal pouch. If total colectomy with rectal mucosectomy is to be performed, then reconstruction options include J-pouch ileo-anal anastomosis, straight ileo-anal anastomosis and permanent ileostomy which is usually necessary in about 10% of patients [80]. In toxic megacolon, blow-hole colostomy (construction of a side hole through the colon wall which is sutured to the skin and allows the colon to decompress, thus avoiding perforation) might be an option if a patient is too sick to tolerate a more extensive procedure.