Toxic megacolon medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Medical therapy of toxic megacolon include stablizing the patient, decompression and medications. Medications for toxic megacolon include corticosteroids, immunosuppresants and antibiotics.

Medical therapy of Toxic megacolon include:^{[1][2][3][4][5][6]}

• 1. General considerations
  • 1.1. Complete bowel rest
  • 1.2. Intravenous fluid support
  • 1.3. Electrocytes monitoring and correction of abnormalities
  • 1.4. Withdrawal of all anticholinergics, antidiarrheal and narcotics
  • 1.5. Rule out infectious etiology
• 2. Decompression
  • 2.1. Rectal tube
  • 2.2. Nasogastric or long naso-intestinal tube

  Note: Long intestinal tubes are considered to be more effective than naso-gastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance.

  • 2.3. Repositioning maneuvers^[7][8]

  Note: Maneuver 1: Asking patients to roll into the prone position for 10-15 minutes every 2-3 hours and encourage them to pass gas.

  Note: Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body.

• 3. Medical management
  • 3.1. Toxic megacolon associated with inflammatory bowel disease(IBD):^[1][9]
    • 3.1.1. Corticosteroids:
      • Preferred regimen (1): Hydrocortisone 100 mg IV q6h
      • Preferred regimen (2): Methylprednisolone 60 mg IV q24h
    • 3.1.2. Immunosuppresants:
      • Preferred regimen (1): Cyclosporin 2 mg/kg q24h for 7 days

      Note: Maintain serum levels between 150 to 250 ng/mL

      • Preferred regimen (2): Infliximab 5 mg/kg for 3 to 7 days
  • 3.2. Toxic megacolon associated with Clostridium difficile ^[10]
    • Preferred regimen (1): Vancomycin 500 mg PO q6h or via a naso-gastric tube AND Metronidazole 500 mg IV q8h

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