Acute distention of the colon (megacolon toxicum) is a rare, life-threatening condition that develops within a few days. It is a complication of intestinal inflammation. What are the symptoms of acute colonic distension and how is it treated?
Acute distention of the colon(megacolon toxicum) is a condition that causes the enlargement and distension of the large intestine. When this happens, the colon cannot remove gas or feces from the body. If they accumulate in the colon, the large intestine may rupture (rupture).
Acute distention of the colon: causes
This is the most serious non-oncological complication of ulcerative colitis. It occurs in 2 percent of patients as a result of refractory progressive disease or fulminant ulcerative colitis to conventional therapy, and may also develop as a complication of pseudomembranous colitis. Other causes may include hypokalemia, opioids, anticholinergics, or a barite infusion of the intestine.
Acute distention of the colon: symptoms
When there is toxic distension of the colon, the large intestine rapidly increases in volume. Symptoms of illness can appear suddenly and include:
- severe general condition
- abdominal pain and flatulence
- high fever
- tachycardia
- increased tension and compression of the abdominal wall
- decrease or disappearance of perist altic murmurs
Acute distention of the colon: diagnosis
The diagnosis consists of a characteristic clinical picture and an overview X-ray of the abdominal cavity. The radiological criterion for the diagnosis of acute colonic distension is the presence of a median transverse colon diameter greater than 6 cm.
Acute distention of the colon: treatment
Patients require intensive supervision. It is necessary to perform serial examination radiographs of the abdominal cavity in order to determine the diameter of the cecum and to detect free air in the abdominal cavity.
Initially, intensive, short conservative treatment is implemented:
- suspension of oral and enteral nutrition and initiation - after insertion of a nasogastric tube - total parenteral nutrition
- feedingintravenous glucocorticosteroids
- administration of broad-spectrum antibiotics or chemotherapeutic agents, including anaerobes (e.g. metronidazole); some also recommend the use of cyclosporin A, which is the only immunosuppressive drug useful in the treatment of toxic colon enlargement (in addition to glucocorticosteroids)
The improvement of the patient's condition is evidenced by a reduction in the circumference of the abdomen and the appearance of perist altic murmurs. The chance of success in conservative treatment is greater, the earlier it is started.
If the patient's condition worsens within the first 48-72 hours or if no improvement is achieved within 5-7 days, the patient should be qualified for surgery. An indication for urgent surgery is also the presence of free air in the abdominal cavity or the constant increase in the transverse dimension of the cecum despite the treatment. It is recommended to perform a colectomy (partial or complete removal of the large intestine) with preservation and closure of the rectum.