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Toxic Megacolon

Downs JWD - MedPix (2006)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Toxic Megacolon

History: This 83 year-old African-American female with a past medical history of hypothyroidism, hypertension, and type II diabetes mellitus presented to the emergency room with one week of constipation. The patient had fallen 2 weeks prior to this presentation and by her report had been placed on acetaminophen/oxycodone for pain in her right knee. Shortly thereafter, the frequency of her stools decreased. At presentation, the patient had not passed stool in 5 days. Of note, the patient was admitted about one month prior for hyponatremia that was complicated by Clostridium difficile colitis. The patient was still receiving oral vancomycin for treatment. On arrival, she denied any abdominal pain, nausea or vomiting, recent diarrhea, abdominal distension, dark or bloody stools, or bright red blood per rectum. Evaluation by the emergency physician noted a heart rate >150 beats per minute. An electrocardiogram showed new onset atrial fibrillation with rapid ventricular response. The patient was admitted to the cardiac care unit for further evaluation of the new dysrhythmia. An acute abdominal series was obtained on admission for evaluation of constipation. Over the first night of admission, the dysrhythmia spontaneously converted to sinus tachycardia. The patient had two large solid bowel movements, but then developed severe diffuse abdominal pain and distension with altered mental status by morning. A surgical consult and further imaging were obtained.

Findings: Supine Abdominal Film: There is a large amount of air and stool seen throughout the colon. The colon is diffusely dilated. The cecum is dilated to 11.5cm. The transverse colon is dilated to 9.5cm. There is air seen to the level of the rectum. CT, Abdomen/Pelvis with Intravenous and Enteric Contrast: There is diffuse dilation of the colon with air and fluid levels present. There is diffuse wall thickening and enhancement in the rectosigmoid colon. The descending, transverse, and ascending colon are dilated to as much as 8.5cm. The colonic wall enhances, but is not abnormally thickened. There is contrast within the small bowel. A small amount of air is seen within the small bowel and terminal ileum. There is no evidence of perforation or extraluminal process.

Ddx: 1. Toxic Megacolon 2. Distal Colonic Obstruction 3. Ileus 4. Ogilvie syndrome 5. Volvulus

Dxhow: Computed Tomography demonstrating diffusely dilated colon with clinical evidence of toxicity.

Exam: Vitals: T 101.0F, HR 88 (with beta blockade), BP 113/50, RR 28, Sa 97% 2L NC Exam: Generally ill-appearing, distended abdomen without bowel sounds, tympanitic and tender diffusely, peritoneal signs Labs: WBC: 8.8 (51% bands), Anion Gap: 16, ABG: 7.399/28.4/73/17.5/95%, Lactate 5.7

No MeSH data available.


There is diffuse dilation of the colon with air and fluid levels present. There is diffuse wall thickening and enhancement in the rectosigmoid colon. The descending, transverse, and ascending colon are dilated to as much as 8.5cm.  These features are consistent with a diagnosis of toxic megacolon.
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MPX1359_synpic29149: There is diffuse dilation of the colon with air and fluid levels present. There is diffuse wall thickening and enhancement in the rectosigmoid colon. The descending, transverse, and ascending colon are dilated to as much as 8.5cm. These features are consistent with a diagnosis of toxic megacolon.


Toxic Megacolon

Downs JWD - MedPix (2006)

There is diffuse dilation of the colon with air and fluid levels present. There is diffuse wall thickening and enhancement in the rectosigmoid colon. The descending, transverse, and ascending colon are dilated to as much as 8.5cm.  These features are consistent with a diagnosis of toxic megacolon.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1359&req=5

MPX1359_synpic29149: There is diffuse dilation of the colon with air and fluid levels present. There is diffuse wall thickening and enhancement in the rectosigmoid colon. The descending, transverse, and ascending colon are dilated to as much as 8.5cm. These features are consistent with a diagnosis of toxic megacolon.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Toxic Megacolon

History: This 83 year-old African-American female with a past medical history of hypothyroidism, hypertension, and type II diabetes mellitus presented to the emergency room with one week of constipation. The patient had fallen 2 weeks prior to this presentation and by her report had been placed on acetaminophen/oxycodone for pain in her right knee. Shortly thereafter, the frequency of her stools decreased. At presentation, the patient had not passed stool in 5 days. Of note, the patient was admitted about one month prior for hyponatremia that was complicated by Clostridium difficile colitis. The patient was still receiving oral vancomycin for treatment. On arrival, she denied any abdominal pain, nausea or vomiting, recent diarrhea, abdominal distension, dark or bloody stools, or bright red blood per rectum. Evaluation by the emergency physician noted a heart rate >150 beats per minute. An electrocardiogram showed new onset atrial fibrillation with rapid ventricular response. The patient was admitted to the cardiac care unit for further evaluation of the new dysrhythmia. An acute abdominal series was obtained on admission for evaluation of constipation. Over the first night of admission, the dysrhythmia spontaneously converted to sinus tachycardia. The patient had two large solid bowel movements, but then developed severe diffuse abdominal pain and distension with altered mental status by morning. A surgical consult and further imaging were obtained.

Findings: Supine Abdominal Film: There is a large amount of air and stool seen throughout the colon. The colon is diffusely dilated. The cecum is dilated to 11.5cm. The transverse colon is dilated to 9.5cm. There is air seen to the level of the rectum. CT, Abdomen/Pelvis with Intravenous and Enteric Contrast: There is diffuse dilation of the colon with air and fluid levels present. There is diffuse wall thickening and enhancement in the rectosigmoid colon. The descending, transverse, and ascending colon are dilated to as much as 8.5cm. The colonic wall enhances, but is not abnormally thickened. There is contrast within the small bowel. A small amount of air is seen within the small bowel and terminal ileum. There is no evidence of perforation or extraluminal process.

Ddx: 1. Toxic Megacolon 2. Distal Colonic Obstruction 3. Ileus 4. Ogilvie syndrome 5. Volvulus

Dxhow: Computed Tomography demonstrating diffusely dilated colon with clinical evidence of toxicity.

Exam: Vitals: T 101.0F, HR 88 (with beta blockade), BP 113/50, RR 28, Sa 97% 2L NC Exam: Generally ill-appearing, distended abdomen without bowel sounds, tympanitic and tender diffusely, peritoneal signs Labs: WBC: 8.8 (51% bands), Anion Gap: 16, ABG: 7.399/28.4/73/17.5/95%, Lactate 5.7

No MeSH data available.