​Surgery - Toxic Megacolon

​Surgery - Toxic Megacolon 
Introduction 
severe colitis accompanied by partial or complete colon dilatation.

Etiology 

Most frequently brought on by a severe flare-up of ulcerative colitis, but it can also happen in cases of Crohn's disease, pseudo-membranous colitis (an infection caused by Clostridium difficile), and other infectious colitis.

Epidemiology 
May appear in 3–10% of ulcerative colitis patients, less frequently in Crohn's disease patients, and rarely in infections aetiologies.
H HISTORY
The patient has discomfort and cramping in her abdomen and is generally ill. a sudden and violent diarrhea.

Examination 
hypotension, tachycardia, dehydration, and pyrexia. a sensitive, swollen abdomen, or a decrease in bowel movements.

Pathogenesis 

The gut wall's muscular layers are affected by inflammation. The colon becomes distended and there is a danger of perforation due to neurogenic loss of motor tone. On histological examination, mucosal sloughing, tissue necrosis, and muscle weakening are observed. Systemic poisoning results from colonic bacterial overgrowth absorbed through inflamed colonic mucosa.


Investigations 

Blood: significantly elevated WCC, lowered K+ in U&Es, lowered Alb, and elevated CRP.
Radiology: A dilated colon (>6 cm) will be visible on an AXR or CT scan. There is a considerable probability of perforation if the measurement is greater than 10 cm. An erect CXR should be done to look for air under the diaphragm, which would indicate a perforation. It is not recommended to use barium enema since it could puncture.

Managaement 

Medical: Multidisciplinary care with the assistance of surgeons, gastroenterologists, and critical care is the best way to manage severe colitis. Depending on the cause, aggressive fluid resuscitation and intravenous antibiotics with or without steroids are recommended. It is possible to utilize IV cyclosporine therapy for ulcerative colitis. In spite of medicinal therapy reasons for surgery, early and routine surgical assessment is crucial when there is clinical deterioration and increasing dilatation on serial abdominal radiographs.

Surgical: Thirty percent of patients seek for urgent care. In most situations, an ileostomy combined with a total colectomy is the best course of surgery.


Complications 
rupture as well as peritonitis. Sepsis systemic.

Prognosis 
high death rate (20–30%), particularly in cases of perforation