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Toxic megacolon secondary to infective colitis in children
Insights
Toxic megacolon in children with infective colitis is a rare but severe condition. Prompt diagnosis and aggressive treatment are crucial due to its high mortality rate.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- Toxic megacolon is a life-threatening complication of severe colitis.
- Infective colitis rarely leads to toxic megacolon in pediatric patients.
Purpose of the Study:
- To analyze the clinical course, pathology, treatment, and outcomes of toxic megacolon secondary to infective colitis in children.
Main Methods:
- Retrospective review of medical records for 20 children treated for infective colitis with toxic megacolon over 12 months.
- Analysis of clinical presentation, laboratory findings, imaging, and treatment strategies.
Main Results:
- Patients presented with nonspecific gastroenteritis, rapidly progressing to toxic signs, severe colonic dilatation, and elevated inflammatory markers.
- Salmonella enteritidis was identified in 60% of cases; 15% of patients required surgery, and 15% died.
- Intensive therapy including antibiotics, decompression, and total parenteral nutrition was necessary, with prolonged hospitalization.
Conclusions:
- Infective colitis-associated toxic megacolon in children is a fulminant illness with a high mortality rate.
- The disease progresses through distinct stages: acute toxic, gut failure, and convalescence/deterioration.
- Early diagnosis and aggressive management are critical for improving outcomes.
Background And Purpose:
Toxic megacolon is a fulminating and potentially lethal complication of severe colitis. Toxic megacolon secondary to infective colitis in children is rare. We analyzed the clinical course, pathology, treatment, and outcome of toxic megacolon secondary to infective colitis in children.
Methods:
The medical records of all 20 children treated for infective colitis complicated with toxic megacolon during a 12-month (October 1997-October 1998) period were retrospectively reviewed.
Results:
There were 10 boys and 10 girls, with a mean (+/- standard deviation, SD) age of 26.2 +/- 12.9 months (range, 6-57 mo). With an initial presentation of nonspecific gastroenteritis syndrome lasting several days, the disease progressed rapidly. In the acute stage, most patients developed toxic signs such as mental change, ranging from irritability to stupor (20, 100%), fever (19, 95%), tachycardia (20, 100%), abdominal distension (20, 100%), and abnormal stool pattern (19, 95%). Initial investigations revealed anemia (11, 55%), leukocytosis (11, 55%), and elevated levels of C-reactive protein ranging from 25.0 mg/L to 483.0 mg/L with a mean +/- SD of 185.7 +/- 129.1 mg/L (normal range, < 8 mg/L) (20, 100%). Salmonella enteritidis (12 patients, 60%) and Clostridium difficile (1, 5%) were isolated from stool samples in some cases. Plain abdominal x-rays revealed severe colonic dilatation. Prolonged hospitalization (mean, 33.6 d) and intensive therapy including a combination of broad-spectrum antibiotics, physical decompression, and total parenteral nutrition were necessary. Three patients (15%) underwent surgical management; the pathologic findings in these patients demonstrated severe transmural inflammation. We believe that bacterial and/or endotoxin translocation played an important role in gut failure. Three patients (15%) in the study died.
Conclusion:
Toxic megacolon in infective colitis is a fulminating illness that has a high mortality rate. The disease course can be divided into three stages: the acute toxic stage, the gut failure stage, and the convalescence or deterioration stage. Early diagnosis and aggressive management are important.