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Early recognition of toxic megacolon
Journal of Clinical Gastroenterology
|April 1, 1987
Summary
Increased small bowel gas in severe colitis patients may signal a higher risk for toxic megacolon (TMC). Early detection and treatment of TMC in these patients improved survival rates.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Increased small bowel gas is common in toxic megacolon (TMC).
- Its presence in severe colitis may indicate predisposition to TMC.
Purpose of the Study:
- To evaluate if increased small intestinal gas identifies patients with severe colitis at risk for TMC.
- To assess the correlation between small bowel gas and disease outcomes.
Main Methods:
- Studied 69 consecutive patients with severe ulcerative colitis.
- Measured intestinal gas using a planimeter on plain abdominal films.
- Compared outcomes and clinical findings between groups with normal and increased small bowel gas.
Main Results:
- Seven of 31 patients with increased small bowel gas developed TMC; none of 38 with normal gas did.
- Increased gas group showed significantly higher blood pH and base excess.
- Early TMC detection in the high-risk group led to survival with prompt treatment.
Conclusions:
- Persistent abnormal small bowel gas and metabolic alkalosis identify severe colitis patients at high risk for TMC.
- Strict surveillance of these patients enables early TMC recognition and improved prognosis.
- Early detection and aggressive treatment of TMC are crucial for patient survival.