Presentation
A previously unreported case of localized leukocytoclastic vasculitis of the left colon resulting in the impressive presentation of megacolon, without the presence of any precipitating factor or associated systemic disease is presented here, with an overview [ncbi.nlm.nih.gov]
Entire Body System
- Pain
Abstract We report the case of a 44-year-old white man who presented with progressively worsening crampy abdominal pain and distention. [ncbi.nlm.nih.gov]
Common symptoms are pain, distention of the abdomen, fever, rapid heart rate, and dehydration. This is a life-threatening complication that requires immediate medical treatment. [mountsinai.org]
Symptoms These are signs and symptoms related to toxic megacolon: Swelling of the belly Pain in the belly Fever Rapid heart rate Shock Diarrhea Risk factors Toxic megacolon is a complication of these conditions: Ulcerative colitis. [hopkinsmedicine.org]
- Inflammation
Colitis is inflammation in your colon (large intestine). Colitis typically affects the mucous lining of your intestines. But severe and prolonged inflammation can eventually spread to the deeper layers of your colon, including the muscles. [my.clevelandclinic.org]
CONCLUSIONS: The recurrence of constipation after surgical treatment can result from the progression of chagasic neuronal degeneration in the preserved colon, and may be preventable by intra-operative evaluation of whether signs of neuronal degeneration or inflammation [ncbi.nlm.nih.gov]
The inflammation of Crohn disease is nearly always found in the ileocecal region. [mountsinai.org]
Acute diverticulitis occurs when the neck of a diverticulum is occluded by stool, inflammation, or food particles, resulting in a microperforation of the diverticulum and surrounding pericolic inflammation. [doi.org]
- Fever
Common symptoms are pain, distention of the abdomen, fever, rapid heart rate, and dehydration. This is a life-threatening complication that requires immediate medical treatment. [mountsinai.org]
Symptoms These are signs and symptoms related to toxic megacolon: Swelling of the belly Pain in the belly Fever Rapid heart rate Shock Diarrhea Risk factors Toxic megacolon is a complication of these conditions: Ulcerative colitis. [hopkinsmedicine.org]
The rapid widening of the colon may cause the following symptoms to occur over a short period of time: Painful, distended abdomen Fever (sepsis) Diarrhea (usually bloody) The health care provider will perform a physical exam. [medlineplus.gov]
Fever. Low blood pressure. Mental confusion. Fatigue/malaise. What is the most common cause of toxic megacolon? Technically, any type of colitis can lead to toxic megacolon if it’s severe enough. [my.clevelandclinic.org]
[…] secretions in the intestine → colonic dilation Clinical features Gradual abdominal distention Abdominal pain; constipation/diarrhea Tympanitic abdominal percussion; decreased frequency of bowel sounds Signs of colonic ischemia or impending perforation: Fever [amboss.com]
- Sepsis
You may receive antibiotics to prevent sepsis (a severe infection). If the condition does not improve, it can be fatal. Colon surgery is usually needed in such cases. [medlineplus.gov]
You may receive antibiotics to prevent sepsis (a severe infection). Outlook (Prognosis) If the condition does not improve, it can be fatal. Colon surgery is usually needed in such cases. [mountsinai.org]
[…] was established with great difficulty and the infant underwent serial surgeries, ending up with an extended myotomy-myectomy (Ziegler's procedure) as a curative approach, with favorable immediate postoperative evolution.However, the patient developed sepsis [ncbi.nlm.nih.gov]
Patients typically present with signs of sepsis (tachycardia, hypotension) and a history of abdominal pain and bloody diarrhea. Abdominal x-rays demonstrate a colonic dilation, with/without air-fluid levels, and preserved haustrae. [amboss.com]
Complications If untreated, a toxic megacolon can result in severe complications, such as: Bleeding and blood loss Whole-body infection (sepsis) Abnormal hole in the colon (perforation) Shock Toxic megacolon can be deadly if not treated. [hopkinsmedicine.org]
- Weakness
On physical examination, his abdomen was remarkably distended with generalized tenderness, and weak bowel sounds. Abdominal X-ray showed megacolon at the splenic flexure and a contrast medium enema study showed tapering of the upper rectum. [ncbi.nlm.nih.gov]
When to call the healthcare provider Seek immediate medical help or have someone call 911 if you have severe stomach pain and these symptoms: Frequent diarrhea Bloody diarrhea Swelling in your belly Fever Rapid heart rate Signs of shock, such as a weak [hopkinsmedicine.org]
[…] urinary retention (difficulty in passing urine), • gastric retention (when the stomach does not empty properly), • uncontrolled narrow-angle glaucoma (increased eye pressure even with treatment), • myasthenia gravis (a disease of the nerves causing muscle weakness [mymemory.translated.net]
Gladman et al. (2007) reported weaknesses with this study involving their choice of control group, despite its use by many later reports [1]. [bmcgastroenterol.biomedcentral.com]
Gastrointestinal
- Diarrhea
Abstract Intestinal microvillous disorders are an uncommon cause of severe diarrhea, with very poor prognosis. [ncbi.nlm.nih.gov]
When to call the healthcare provider Seek immediate medical help or have someone call 911 if you have severe stomach pain and these symptoms: Frequent diarrhea Bloody diarrhea Swelling in your belly Fever Rapid heart rate Signs of shock, such as a weak [hopkinsmedicine.org]
Complications may include: Perforation of the colon Sepsis Shock Death Go to the emergency room or call the local emergency number (such as 911) if you develop severe abdominal pain, especially if you also have: Bloody diarrhea Fever Frequent diarrhea [medlineplus.gov]
Fever Frequent diarrhea Rapid heart rate Tenderness when the abdomen is pressed Abdominal distention Prevention Treating diseases that cause toxic megacolon, such as ulcerative colitis or Crohn disease, can prevent this condition. [mountsinai.org]
- Abdominal Pain
Abstract We report the case of a 44-year-old white man who presented with progressively worsening crampy abdominal pain and distention. [ncbi.nlm.nih.gov]
Patients with acute/chronic megacolon typically present with abdominal pain, bloating, and constipation. [amboss.com]
Most predominant symptoms were constipation, abdominal pain, distention and gas distress. [bmcgastroenterol.biomedcentral.com]
Complications may include: Perforation of the colon Sepsis Shock Death Go to the emergency room or call the local emergency number (such as 911) if you develop severe abdominal pain, especially if you also have: Bloody diarrhea Fever Frequent diarrhea [medlineplus.gov]
- Abdominal Distension
She presented clouded sensorium and abdominal distension, with closed alvus. The CT scan showed a distension of the colon, with severe fecal impaction. [ncbi.nlm.nih.gov]
- Intestinal Disease
Abstract Mycobacterium avium, subspecies paratuberculosis (MAP) causes a chronic disease of the intestines in dairy cows and a wide range of other animals, including nonhuman primates, called Johne's ("Yo-knee's") disease. [ncbi.nlm.nih.gov]
Cardiovascular
- Tachycardia
Case report 1: a 75-year-old woman with diabetes mellitus, hypertension, tachycardia with atrial fibrillation, bilateral pleural effusions and previous cerebral hemorrhage was admitted in our hospital. [ncbi.nlm.nih.gov]
Patients typically present with signs of sepsis (tachycardia, hypotension) and a history of abdominal pain and bloody diarrhea. Abdominal x-rays demonstrate a colonic dilation, with/without air-fluid levels, and preserved haustrae. [amboss.com]
Systemic uptake of cytokines and other inflammatory mediators leads to fever, tachycardia, hypotension, and other signs of systemic toxicity. [emedicine.medscape.com]
- Weak Pulse
pulse, cool or clammy skin, dilated eyes, confusion, and rapid or shallow breathing [hopkinsmedicine.org]
Skin
- Ulcer
Unfortunately, the data on the incidence of toxic megacolon in ulcerative colitis versus Crohn disease are contradicting; some studies show a higher incidence in patients with Crohn disease compared to those with ulcerative colitis (1-2.5% ulcerative [emedicine.medscape.com]
[…] disease to ulcerative colitis. [ncbi.nlm.nih.gov]
Ulcerative colitis is categorized according to location. Proctitis involves only the rectum. Proctosigmoiditis affects the rectum and sigmoid colon. Left-sided colitis encompasses the entire left side of the large intestine. [mountsinai.org]
Toxic dilation of the colon; Megarectum; Inflammatory bowel disease - toxic megacolon; Crohn disease - toxic megacolon; Ulcerative colitis - toxic megacolon Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. [medlineplus.gov]
CT On CT there is an additional loss of haustral markings, with pseudopolyps often extending into the lumen due to ulceration of the colonic wall. [radiopaedia.org]
Musculoskeletal
- Arthritis
Learn more about arthritis and other health issues in our Women's Health Center. Comprehensive women's health information provided by MerckSource.com. Learn more about arthritis and other health issues in our Women's Health Center. [web.archive.org]
Neurologic
- Confusion
Examination was notable for confusion and diffuse abdominal tenderness with tympany. Testing for Clostridioides difficile was positive. Funding and Disclosures This article was published on October 1, 2022, at NEJM.org. [nejm.org]
[…] immediate medical help or have someone call 911 if you have severe stomach pain and these symptoms: Frequent diarrhea Bloody diarrhea Swelling in your belly Fever Rapid heart rate Signs of shock, such as a weak pulse, cool or clammy skin, dilated eyes, confusion [hopkinsmedicine.org]
Mental confusion. Fatigue/malaise. What is the most common cause of toxic megacolon? Technically, any type of colitis can lead to toxic megacolon if it’s severe enough. However, it’s most commonly associated with inflammatory bowel disease (IBD). [my.clevelandclinic.org]
Urogenital
- Kidney Failure
Other risk factors include diabetes, organ transplants, kidney failure, suppressed immunity, and chronic obstructive pulmonary disease. [hopkinsmedicine.org]
Treatment may include: Breathing machine (mechanical ventilation) Dialysis for kidney failure Drugs to treat low blood pressure, infection, or poor blood clotting Fluids given directly into a vein Oxygen If rapid widening is not treated, an opening or [medlineplus.gov]
If you have sepsis, you may need critical care, such as mechanical ventilation for respiratory failure or dialysis for kidney failure. [my.clevelandclinic.org]
Workup
(See also Etiology, Presentation, and Workup.) Toxic Megacolon. A 72-year-old woman presented with vomiting and abdominal distention. [emedicine.medscape.com]
Colonoscopy
- Colitis
Colitis caused by CMV colitis should be considered in elderly people with diarrhea. 2010 Wiley-Liss, Inc. [ncbi.nlm.nih.gov]
Etiology Ulcerative colitis is the most common cause, other less common causes of toxic megacolon and colitis include: Crohn disease infectious colitis (especially C. difficile colitis) neutropenic colitis ischemic colitis radiation-induced colitis colonic [radiopaedia.org]
Toxic megacolon is a rare but serious complication of severe colitis. Colitis is inflammation in your colon (large intestine). Colitis typically affects the mucous lining of your intestines. [my.clevelandclinic.org]
However, with the rising incidence of C difficile infections, pseudomembranous colitis must always be considered, even in patients with IBD. Educate patients about ulcerative colitis, Crohn disease, and indeterminate colitis. [emedicine.medscape.com]
[…] disease, infectious colitis, and pseudomembranous colitis. [doi.org]
Treatment
Abstract Persistent megacolon that results from frequent episodes of fecal impaction without adequate treatment is a rare and seldom reported condition in the elderly. [ncbi.nlm.nih.gov]
Toxic megacolon is a life-threatening condition that needs immediate treatment. [hopkinsmedicine.org]
Most cases respond to medical treatment. Advanced cases of megacolon and megarectum can be treated surgically by Duhamel technique. [jcol.elsevier.es]
Prognosis
Abstract Intestinal microvillous disorders are an uncommon cause of severe diarrhea, with very poor prognosis. [ncbi.nlm.nih.gov]
Treatment and prognosis Specific management depends on the underlying etiology and may involve a combination of supportive, pharmacological, and surgical management. References Promoted articles (advertising) [radiopaedia.org]
Outlook (Prognosis) If the condition does not improve, it can be fatal. Colon surgery is usually needed in such cases. [mountsinai.org]
Outlook / Prognosis Can you survive toxic megacolon? Your chances are good if you seek treatment soon enough. The overall survival rate for those treated for toxic megacolon is around 93%. [my.clevelandclinic.org]
Etiology
The etiology was established by means of laboratory and histological features. Based on epidemiological data, the authors concluded that vertical transmission was the most probable route of acquisition. [ncbi.nlm.nih.gov]
There are three etiological types of megacolon: acute, chronic, and toxic megacolon. [amboss.com]
Treatment and prognosis Specific management depends on the underlying etiology and may involve a combination of supportive, pharmacological, and surgical management. References Promoted articles (advertising) [radiopaedia.org]
Epidemiology
Based on epidemiological data, the authors concluded that vertical transmission was the most probable route of acquisition. This diagnosis should be considered in children presenting similar complaints, even those living away from endemic areas. [ncbi.nlm.nih.gov]
Chagas megacolon. [3] Of the 34% of asymptomatic patients who demonstrated similar patterns of autoantibodies, 84% of these individuals also had levels of beta1 autoantibody that are typical for Chags cardiomyopathy, which the authors stated mirrored the epidemiologic [emedicine.com]
Pathophysiology
Complications and management of fecal impaction and the pathophysiology of megacolon in the literature are reviewed and discussed. [ncbi.nlm.nih.gov]
Novel concepts in the diagnosis, pathophysiology and management of idiopathic megabowel. Colorectal Dis. 2008; 10 (6): p.531-538. doi: 10.1111/j.1463-1318.2007.01457.x. | Open in Read by QxMD Beattie GC, Peters RT, Guy S, Mendelson RM. [amboss.com]
The pathophysiology of chronic megacolon is incompletely understood. It likely represents an amalgam of primary disorders involving muscular and nervous systems of the intestine. Much basic science work has been performed in this area. [emedicine.com]
Prevention
CONCLUSION: A timely surgical intervention in recalcitrant fecal impactions may prevent possible stercoral ulcer perforation with a high mortality. [ncbi.nlm.nih.gov]
Treating diseases that cause toxic megacolon, such as ulcerative colitis or Crohn disease, can prevent this condition. [mountsinai.org]
You may be given an IV of fluids and electrolytes to help nourish your body and prevent dehydration. Surgery. [hopkinsmedicine.org]