Toxic megacolon medical therapy

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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