Defining Surgical Therapy for Pseudomembranous Colitis With Toxic Megacolon

• DOI: 10.1097/mcg.0b013e31804bbe12
• Publication Date: 2008-04-18T07:03:12Z
• Authors: Loren Berman; Tobias Carling; Tamara N. Fitzgerald; Robert L. Bell; Andrew J. Duffy; Walter E. Longo; Kurt E. Roberts
• Keywords: Toxic megacolon; Pseudomembranous colitis; Megacolon

Pseudomembranous colitis has increased in incidence and severity over the past 10 years. Toxic megacolon is a rare but reported presentation of severe pseudomembranous colitis. This article reviews cases Clostridium difficile with toxic literature introduces an additional case that underscores importance early diagnosis guiding appropriate therapy.A systematic review was performed to identify previous reports presenting megacolon, outcomes each these analyzed. The focused on atypical presentations immunocompromised patients.Seventeen C. as were identified. overall mortality rate 50% (9/18). Fifteen patients underwent surgery associated 50%. Thirteen had subtotal colectomy. Seven (39%) taking immunosuppressant medications, 5 (28%) presented symptoms. Three (76%) those immunosuppressed. In several cases, failure make resulted worse outcome because therapy delayed.Toxic well-established unusual These are less likely present typical symptoms such diarrhea or risk factors like recent administration antibiotics, so can be challenge. A patient without history inflammatory bowel disease should assumed have until proven otherwise, medical surgical administered accordingly.