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BMJ Case Rep 2018 Sep 30;2018. Epub 2018 Sep 30.

Department of Diagnostic Imaging, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia.

Cureus 2018 May 30;10(5):e2710. Epub 2018 May 30.

Graduate, Pontifical Catholic University of Ecuador, Chagrin Falls, USA.

Crohn's disease (CD) is a granulomatous inflammatory disease that can involve any part of the gastrointestinal tract, from mouth to anus. In most cases, it remits and relapses in the terminal ileum, requiring treatment via steroid boluses. In rare cases, however, CD can involve the pulmonary system presenting as dyspnea on exertion and dry cough. Read More

BMJ Case Rep 2018 Jan 11;2018. Epub 2018 Jan 11.

Department of Intensive Care Unit, Gelderse Vallei Hospital, Ede, The Netherlands.

Z Gastroenterol 2017 Dec 6;55(12):1499-1508. Epub 2017 Dec 6.

Klinik und Poliklinik für Innere Medizin A, Universitätsklinikum Greifswald.

In patients with ileus with dilated intestine in imaging studies, endoscopic decompression appears a feasible option. However, its use is often uncritical and without scientific evidence. Before considering endoscopic intervention, CT-imaging should differentiate between mechanical obstruction and paralytic ileus/intestinal pseudo-obstruction. Read More

Colorectal Dis 2017 Apr;19(4):O97-O102

Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.

Aim: To evaluate the contribution of CT for the management of patients with severe acute exacerbation of colitis (SAC) complicating inflammatory bowel disease (IBD); in particular, its contribution to surgical decision making.

Method: All patients who were admitted to our institution for SAC complicating IBD were divided into two groups: group A (those who received surgical treatment); and group B (those who received medical treatment). Admission CT results were compared between groups. Read More

Pediatr Emerg Care 2016 Nov;32(11):785-788

From the Departments of *Pediatric Surgery and †Pediatrics, University of Mannheim, Medical Faculty of Heidelberg, Mannheim, Germany.

Objectives: Enterocolitis remains the most significant cause of morbidity and mortality in Hirschsprung disease (HD). It could progress into toxic megacolon (TM)-acute dilatation of the colon as accompanying toxic complication of Hirschsprung enterocolitis. It is a devastating complication, especially in infants with so far undiagnosed HD. Read More

BMJ 2016 Oct 13;355:i5264. Epub 2016 Oct 13.

Department of Radiology, East Sussex Hospitals NHS Trust, Eastbourne, UK.

Anaesthesiol Intensive Ther 2016 ;48(2):146-8

Department of Anaesthesiology and Intensive Care, Medical Centre of Postgraduate Education, Warsaw, Poland.

Viszeralmedizin 2015 Aug 4;31(4):280-6. Epub 2015 Aug 4.

Medical Clinic I, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.

Background: Endoscopy is an essential diagnostic and therapeutic modality in the clinical care of inflammatory bowel disease (IBD) patients. Endoscopic therapy can be used for treatment of disease-related strictures, surveillance and resection of intraepithelial neoplasia, and treatment of fistulas or disease-related complications, and is currently being evaluated regarding its capacity in in vivo molecular imaging procedures.

Methods: A literature search using Medline and Science Citation Index was performed in March 2015. Read More

Pediatr Emerg Med Pract 2014 Jul;11(7):1-16; quiz 17-8

Inflammatory bowel disease includes both Crohn disease and ulcerative colitis. Pediatric-onset inflammatory bowel disease differs from adult inflammatory bowel disease in disease type, location, progression, and sex preponderance, and 20% to 30% of inflammatory bowel disease is diagnosed in childhood. Children are more likely than adults to present with extraintestinal manifestations of inflammatory bowel disease (with aphthous ulcers, joint involvement, and growth delay being the most common). Read More

Arch Dis Child Educ Pract Ed 2014 Oct 6;99(5):188, 200. Epub 2014 Feb 6.

Leicester Children's Hospital, Leicester Royal Infirmary, Leicester, UK.

Ann R Coll Surg Engl 2014 Jan;96(1):101E-103E

1Whittington Hospital NHS Trust, UK.

MELAS (mitochondrial cytopathy, encephalomyopathy, lactic acidosis and stroke-like episodes) is a syndrome in which signs and symptoms of gastrointestinal disease are uncommon if not rare. We describe the case of a young woman who presented as an acute surgical emergency, diagnosed as toxic megacolon necessitating an emergency total colectomy. MELAS syndrome was suspected postoperatively owing to persistent lactic acidosis and neurological symptoms. Read More

Case Rep Gastroenterol 2013 11;7(3):409-13. Epub 2013 Sep 11.

Computed Tomography and Magnetic Resonance Imaging Department, Sismanogleio General Hospital, Athens, Greece.

We present a rare case of toxic megacolon accompanied by necrosis of the colon due to chronic dilation caused by stenosis of the sigmoid colon as a complication of diverticulitis. The patient presented at the emergency department with diffuse abdominal pain, fever (38.8°C) and tachycardia (120 beats/min). Read More

BMJ Case Rep 2013 Sep 10;2013. Epub 2013 Sep 10.

Department of General Surgery, Kasturba Medical College, Manipal, Karnataka, India.

Cytomegalovirus (CMV) infection causes significant morbidty and mortality in immunopromised patients. Though it is usually silent in immunocompetent adults, rarely it can cause serious life-threatening complications. Gastrointestinal tract is one of the commonly involved organs, where it produces a spectrum of clinical manifestation ranging from mild non-specific abdominal pain and diarrhoea to severe infection with toxic megacolon and death. Read More

Ugeskr Laeger 2013 Aug;175(35):1965-6

Gastroenterologisk Afdeling, Medicinsk Center, Aalborg Universitetshospital.

A 38-year-old man with a ten year long history of primary sclerosing cholangitis without previous symptoms of inflammatory bowel disease was admitted to hospital after a few weeks with abdominal pain, diarrhoea and fever. A computed tomography revealed that the colon was dilated to a diameter of 17 cm. Based on a diagnosis of toxic megacolon, a subtotal colectomy and an ileostomy were carried out. Read More

BMJ 2013 Feb 14;346:f563. Epub 2013 Feb 14.

Department of Paediatric Gastroenterology, Hepatology and Nutrition, Yorkhill, Royal, Hospital for Sick Children, Glasgow G3 8SJ, UK.

Can J Gastroenterol 2012 Sep;26(9):627-30

Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, British Columbia.

Microscopic forms of colitis have been described, including collagenous colitis, a possibly heterogeneous disorder. Collagenous colitis most often appears to have an entirely benign clinical course that usually responds to limited treatment. Sometimes significant extracolonic disorders, especially arthritis, spondylitis, thyroiditis and skin disorders, such as pyoderma gangrenosum, dominate the clinical course and influence the treatment strategy. Read More

Intern Emerg Med 2013 Mar 26;8(2):185-6. Epub 2012 Aug 26.

Intern Emerg Med 2012 Oct 28;7(5):487-8. Epub 2012 Jul 28.

Clin Radiol 2012 Aug;67(8):774-81

Department of Radiology, Cork University Hospital and University College Cork, Cork, Ireland.

Aim: To determine the diagnostic yield and clinical value of plain film of the abdomen (PFA) in Crohn's disease (CD) patients and to determine whether performance of PFA yields definitive diagnostic information or whether additional imaging examinations are required.

Materials And Methods: One hundred and seventy-seven CD patients underwent 643 PFAs during the period September 1992 to August 2008. Two radiologists blinded to the clinical details independently evaluated individual PFAs and/or their reports for abnormal findings using the following criteria: normal, small bowel (SB) findings; colonic findings, acute CD complications, extra-colonic findings; global assessment/impression. Read More

Clin Imaging 2011 Nov-Dec;35(6):431-6

Department of Radiology, Besançon University Hospital, 3 bvd Flelming, F-25030 Besançon, France.

Objective: The objective of the study was to evaluate computed tomography (CT) in the differential diagnosis of patients with toxic megacolon (TM) complicating severe acute colitis (SAC) and patients with SAC but no TM.

Materials And Methods: We identified 16 patients who presented clinically complicated SAC and CT examination before surgery. The CT scans of these patients were retrospectively evaluated in consensus by two abdominal radiologists blinded to the clinical and pathological results for CT findings of SAC, i. Read More

Inflamm Bowel Dis 2012 Mar;18(3):584-91

Division of Gastroenterology and Hepatology, Department of Medicine, Virchow Hospital, Charité Medical School, Humboldt-University of Berlin, Germany.

Toxic megacolon represents a dreaded complication of mainly inflammatory or infectious conditions of the colon. It is most commonly associated with inflammatory bowel disease (IBD), i.e. Read More

J Trauma 2011 Aug;71(2):E44

Division of General Surgery, Department of Surgery, Huailien Armed Forces General Hospital, Huailien, Taiwan, Republic of China.

BMJ Case Rep 2010 Aug 26;2010. Epub 2010 Aug 26.

Department of Surgery, Basildon & Thurrock University Hospitals NHS Foundation Trust, Basildon, UK.

A case of undiagnosed congenital idiopathic megacolon in a 16-year-old boy who presented with toxic megacolon and cardiovascular instability with a background of longstanding constipation is presented. He underwent life-saving subtotal colectomy from which he made a full recovery. Read More

N Engl J Med 2009 Oct;361(15):1487-96

Department of Surgery, Massachusetts General Hospital, and Harvard Medical School, USA.

Acta Paediatr 2009 Nov 24;98(11):1850-2. Epub 2009 Jul 24.

Department of Emergency Medicine, Taipei City Hospital, Ren-Ai branch, Taipei, Taiwan.

Unlabelled: Rotavirus is a leading cause of gastroenteritis in young children, which may indicate hospitalization due to dehydration and electrolyte imbalance. Most cases are self-limited with good prognosis. The association between rotavirus and toxic megacolon has never been mentioned in the literature. Read More

Gastroenterology 2009 Jul 6;137(1):e5-6. Epub 2009 Jun 6.

Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota, USA.

AIDS Read 2008 Sep;18(9):458-60

Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA.

Am J Gastroenterol 2008 Jun 28;103(6):1524-31. Epub 2008 May 28.

Division of Gastroenterology, Hepatology & Nutrition, The Hospital of Sick Children, Toronto, Canada.

Background: Toxic megacolon (TMC) denotes a rare clinical syndrome accompanied by colonic dilatation, and is a serious complication of inflammatory bowel disease (IBD). This study assessed the clinical and radiologic characteristics of TMC in children with IBD.

Methods: A systematic search identified patients with IBD-associated TMC and matched them by age to controls with ulcerative colitis without evidence of TMC. Read More

Gastrointest Endosc Clin N Am 2007 Apr;17(2):341-60, vi-vii

Division of Gastroenterology, University of Washington Medical Center, 1959 Northeast Pacific Avenue, Suite AA103P, Box 356424, Seattle, WA 98195, USA.

Acute colonic pseudo-obstruction (ACPO) is a syndrome of massive dilation of the colon without mechanical obstruction that develops in hospitalized patients with serious underlying medical and surgical conditions. Increasing age, cecal diameter, delay in decompression, and status of the bowel significantly influence mortality, which is approximately 40% when ischemia or perforation is present. Evaluation of the markedly distended colon involves excluding mechanical obstruction and other causes of toxic megacolon such as Clostridium difficile infection and assessing for signs of ischemia and perforation. Read More

Eur J Radiol 2007 Mar 2;61(3):442-8. Epub 2007 Jan 2.

Department of Diagnostic and Interventional Radiology, Maggiore della Carità University Hospital, A. Avogadro Eastern Piemonte University, Corso Mazzini 18, 28100 Novara, Italy.

Inflammatory bowel disease, including Crohn's disease and UC, is a chronic disorder of the gastrointestinal tract. The inflammatory process in UC is confined to the mucosa and submucosa and it involves only the colon. In contrast, in Crohn's disease the inflammation process extends through the bowel wall layers and it can involve any part of gastrointestinal tract. Read More

Endocr J 2006 Aug 10;53(4):523-9. Epub 2006 Jul 10.

Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.

Multiple endocrine neoplasia (MEN) type 2B is a rare hereditary disorder characterized by medullary thyroid carcinoma, pheochromocytoma, and neuroma. Early signs of MEN 2B are usually neuroma, gastrointestinal problems, and medullary thyroid carcinoma. Noncardiogenic pulmonary edema is rare as a presenting symptom. Read More

Praxis (Bern 1994) 2005 Oct;94(43):1671-9

Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg.

Complications of chronic inflammatory bowel disease are nowadays relatively rare due to improved surgical and conservative treatment. They are better recognized with modern diagnostic techniques and can be more easily classified and thus treated. Analyses of large cohorts demonstrate that the survival of patients is still not completely normal. Read More

Transpl Int 2005 Apr;18(4):470-4

Department of General and Transplant Surgery, Innsbruck University Hospital, Austria.

Diarrhea following solid organ transplantation is a common side effect of some immunosuppressive agents but can also be caused by many pathogens. An outbreak of rotavirus (RV) enteritis presenting with severe diarrhea in four solid organ recipients was analyzed. The first case was diagnosed in a 6-month-old liver recipient who was prehospitalized on a pediatric ward. Read More

Dig Dis Sci 2004 Jan;49(1):138-42

Gastrointestinal Unit, L. Sacco University Hospital, University of Milan, Milan, Italy.

Dtsch Med Wochenschr 2004 Jan;129(4):137-40

Toxikologische Abteilung der II. Medizinischen Klinik, Klinikum rechts der Isar - Technische Universität München, München, Germany.

History: A 71-year-old previously healthy man consumed a mushroom meal containing Amanita phalloides, which he had confused with Agaricus campestris. Approximately 8 hours later, typical gastrointestinal symptoms began with copious loss of fluids. Treatment with penicillin G was initiated followed by a continuous silibinin infusion before the patient was transferred to our toxicological department. Read More

Am J Gastroenterol 2003 Nov;98(11):2363-71

Division of Gastroenterology, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada.

Toxic megacolon (TM) is an infrequent but devastating complication of colitis. Numerous forms of colonic inflammation can give rise to TM but the majority occur in individuals with inflammatory bowel disease (IBD). Recently there has been a marked increase in the number of reports of TM associated with pseudomembranous colitis. Read More

Hosp Med 2002 Dec;63(12):726-31

Weston General Hospital, Weston Super Mare BS23 4TQ.

The plain abdominal radiograph is one of the most frequently requested X-ray examinations by junior surgical and accident and emergency staff. Interpretation is often difficult, but this review outlines normal appearances, suggests a strategy for evaluation, and covers the common pathological appearances seen in hospital practice. Read More

Am J Gastroenterol 2002 May;97(5):1169-75

Gastroenterology Unit I, University La Sapienza, Rome, Italy.

Objectives: In previous retrospective studies in patients with severe ulcerative colitis (UC), small bowel distension was found to characterize a subgroup of patients at higher risk for both toxic megacolon (TMC) and multiple organ dysfunction syndrome (MODS). In this study we prospectively evaluated the prevalence of GI distension and its relationship to clinical outcome in patients with severe UC.

Methods: Of 109 consecutive inpatients with acute UC (admitted to the GI Unit of the University of Rome during the period 1995-2000), 45 had severe colitis. Read More

JBR-BTR 2001 ;84(5):201

Department of Radiology, Algemeen Centrumziekenhuis Antwerpen, Belgium.

Clin Imaging 2001 Sep-Oct;25(5):349-54

Department of Radiology and National Research Council, University Federico, Naples, Italy.

The purpose of this study is to determine the role of CT in the evaluation and in detecting complications in patients with toxic megacolon. A retrospective analysis of CT findings of 18 consecutive patients with toxic megacolon was performed. Underlying etiology included 12 patients with pseudomembranous colitis (PC), four patients with ulcerative colitis and two patients with cytomegalovirus colitis. Read More

S Afr Med J 2000 Dec;90(12):1160

Clin Nucl Med 2001 Feb;26(2):99-104

Department of Nuclear Medicine, Academic Medical Center Amsterdam, The Netherlands.

Purpose: Ulcerative colitis (UC) is a chronic inflammatory bowel disease with frequent exacerbations, including the risk for toxic megacolon and severe complications. In very active disease, colonoscopy should not be performed to assess the severity and the extent of the disease. The aim of the current study was to determine whether Tc-99m HMPAO-labeled white blood cell (WBC) scintigraphy can be used as an alternative to colonoscopy to determine the extent and the severity of the disease in critically ill patients. Read More

Rev Esp Med Nucl 2000 Oct;19(6):453-4

Serviço de Medicina Nuclear dos Hospitais da Universidade de Coimbra. Portugal.

Anesth Analg 2000 Nov;91(5):1300-2

Departments of General Anesthesiology and Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

Implications: We report a case of a patient who developed membranous tracheal disruption after severe vomiting. He subsequently required urgent colectomy for toxic megacolon under general anesthesia. With this challenging situation, we were able to successfully conduct general anesthesia in the presence of tracheal laceration, pneumothorax, and pneumomediastinum. Read More

S Afr Med J 2000 Feb;90(2):117-8

Department of Surgery, University of Natal.

Ital J Gastroenterol Hepatol 1999 Nov;31(8):807-16

Dept. of Gastroenterology and Clinical Microbiology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.

Acute self-limited colitis encompasses several diagnostic possibilities such as infectious colitis, post-antibiotic colitis, drug-induced colitis and should be differentiated from acute forms of inflammatory bowel disease. Diverticular disease in the elderly patient with colonic ischaemia may also give symptoms of acute bloody mucoid rectal discharge and should be recognised, although the clinical picture is usually completely different. Recognition of the causative agent--if possible--is particularly important in the patient with a foudroyant colitis (e. Read More

Radiographics 1999 Jul-Aug;19(4):887-97

Department of Radiology, Saitama Medical School, Japan.

Pseudomembranous colitis (PMC) is a potentially life-threatening acute infectious colitis caused by one or more toxins produced by an unopposed proliferation of Clostridium difficile bacteria. PMC is characterized by the presence of elevated, yellow-white plaques forming pseudomembranes on the colonic mucosa. These plaques can be visualized at both pathologic analysis and endoscopy. Read More

Gastrointest Endosc Clin N Am 1998 Oct;8(4):889-911

Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, Alabama 35294-0007, USA.

The colon is a frequent site of gastrointestinal complications in patients with HIV infection, and these colonic disorders increase in frequency as immunodeficiency worsens. The most common clinical manifestations of colonic disease in AIDS are diarrhea, lower gastrointestinal bleeding, and abdominal pain. Toxic megacolon, intussuseption, typhlitis, idiopathic colonic ulcer, and pneumatosis intestinalis also have been described. Read More

N Engl J Med 1997 Nov;337(21):1532-40