Toxic megacolon surgery

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

Overview

The mainstay of treatment for toxic megacolon is medical therapy. Surgery is usually reserved for patients with either failed medical therapy, progressive toxicity or dilation and signs of perforation.

Indications

The mainstay of treatment for toxic megacolon is medical therapy. Surgery is usually reserved for patients with:^[1]^[2]
- Failed medical therapy
- Progressive toxicity or dilation
- Signs of perforation

Indications for surgery
Absolute	Relative
Pnemuo-peritoneum	Inability to promptly control sepsis
Diffuse peritonitis	Increasing megacolon
Localized peritonitis with increasing abdominal pain and/or colonic distension >10 cm	Failure to improve within 24-48 h
Uncontrolled sepsis	Increasing toxicity or other signs of clinical deterioration
Major hemorrhage	Continued transfusion requirements

Surgery

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Surgery methods of toxic megacolon include:^[3]^[4]^[5]

1. Total or subtotal colectomy and ileostomy with
- 1.1. Hartmann’s pouch
- 1.2. Mucous fistula
- 1.3. Subcutaneous exteriorization of closed distal bowel
2. Total proctocolectomy and ileostomy
3. Diversion procedures
- 3.1. Ileostomy
- 3.2. Cecostomy
- 3.3. Ileostomy with transverse decompressive colostomy (Turnbull “blowhole” procedure)
4. Restorative procedures
- 4.1. Total colectomy and ileo-rectal anastomosis
- 4.2. Restorative proctocolectomy with ileal pouch–anal anastomosis

References

↑ Fischer, Josef (2007). Mastery of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9780781771658.
↑ Bolton RP, Culshaw MA (1986). “Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile”. Gut. 27 (10): 1169–72. PMC 1433873. PMID 3781329.
↑ Kerstens J, Diebels I, de Gheldere C, Vanclooster P (2016). “Blowhole Colostomy for Clostridium difficile-Associated Toxic Megacolon”. Case Rep Surg. 2016: 5909248. doi:10.1155/2016/5909248. PMC 5209592. PMID 28097034.
↑ Ausch C, Madoff RD, Gnant M, Rosen HR, Garcia-Aguilar J, Hölbling N, Herbst F, Buxhofer V, Holzer B, Rothenberger DA, Schiessel R (2006). “Aetiology and surgical management of toxic megacolon”. Colorectal Dis. 8 (3): 195–201. doi:10.1111/j.1463-1318.2005.00887.x. PMID 16466559.
↑ Arnell, Tracey (2004). “Surgical Management of Acute Colitis and Toxic Megacolon”. Clinics in Colon and Rectal Surgery. 17 (01): 71–74. doi:10.1055/s-2004-823073. ISSN 1531-0043.

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[1] Fischer, Josef (2007). Mastery of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9780781771658.

[pmid3781329-2] Bolton RP, Culshaw MA (1986). “Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile”. Gut. 27 (10): 1169–72. PMC 1433873. PMID 3781329.

[pmid28097034-3] Kerstens J, Diebels I, de Gheldere C, Vanclooster P (2016). “Blowhole Colostomy for Clostridium difficile-Associated Toxic Megacolon”. Case Rep Surg. 2016: 5909248. doi:10.1155/2016/5909248. PMC 5209592. PMID 28097034.

[pmid16466559-4] Ausch C, Madoff RD, Gnant M, Rosen HR, Garcia-Aguilar J, Hölbling N, Herbst F, Buxhofer V, Holzer B, Rothenberger DA, Schiessel R (2006). “Aetiology and surgical management of toxic megacolon”. Colorectal Dis. 8 (3): 195–201. doi:10.1111/j.1463-1318.2005.00887.x. PMID 16466559.

[Arnell2004-5] Arnell, Tracey (2004). “Surgical Management of Acute Colitis and Toxic Megacolon”. Clinics in Colon and Rectal Surgery. 17 (01): 71–74. doi:10.1055/s-2004-823073. ISSN 1531-0043.

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