Treatment Outcomes in Patients with Toxic Megacolon

Česká verzia

Authors: R. Fraško; Z. Uchytil; J. Šváb; Výborný J. Krška Z.
Authors place of work: 1. chirurgická klinika VFN, Praha, přednosta prof. MUDr. Zdeněk Krška, CSc.
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 6, s. 339-342.
Category: Monothematic special - Original

Summary

Background:
The aim of the study was to analyze data of patients threated by surgical intervention for toxic megacolon in period from 2005 till 2009 on 1st. dept. of Surgery of 1st. Faculty of Medicine, Charles University in Prague. Pre-disponding illness of toxic megacolon was studied intimately and evaluation of postoperative course especially for morbidity and letality was estimated.

Patients and methods:
Composit retrospective and prospective analysis of patients that underwent operation for diagnose of toxic megacolon. 19 patients were involved in the study and the method of surgical treatment was subtotal colectomy with formation of terminal ileostomy and rectal occlusion in macroscopically disease-free rectal segment in every case.

Results:
Determined collection involved 19 patients, 13 male and 6 female patients with mean age of 51 years. The most frequent reason for toxic megacolon occurence was ulcerative colitis (36.8%, 7 patients), then pseudomembranous colitis (26.3%, 5 patients) and ischemic colitis (15.8%, 3 patients).

The method of surgical treatment was subtotal colectomy with formation of terminal ileostomy and rectal occlusion in macroscopically disease-free rectal segment in every case.

Key words:
toxic megacolon – IBD – Jalan’s diagnostic criteria – subphrenical abscess.

Zdroje

1. Bortlík, M., Lukáš, M. Toxické megakolon. Čas. Lék. čes., 140, 2001, No. 20, p. 619–623.

2. Berman, L. Defining surgical therapy for pseudomembranous colitis with toxic megacolon. J. Clin. Gastroenterol., 2008 May-Jun; 42(5):476-80. PMID: 18277885

3. Lukáš, M., Lukáš, K., Pešková, M. Toxické rozpětí tračníku v průběhu idiopatických střevních zánětů I. Čs. gastroent. Výživa, 1993, 47, s. 229–232.

4. Lukáš, M., Lukáš, K., Pešková, M. Toxické rozpětí tračníku v průběhu idiopatických střevních zánětů II. Čs. gastroent. Výživa, 1994, 48, s. 14–18.

5. Gan, S. I. A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management. Am. J. Gastroenterol., 98(11): 2363–2371.

6. Dítě, P., et al. Toxické megakolon. Akutní stavy v gastroenterologii, Galén 2005, str. 103–109.

7. Ševčík, et al. Intenzivní medicína. Galén, 2003.

8. Zeman, M., et al. Speciální chirurgie. Galén, 2004, str. 295–298.

9. Ruf, G. Toxic megacolon – surgical points of view. Praxis (Bern 1994). 2006 Nov 1; 95(44): 1727–1730.

10. Jalan, K. N., Sirius, B. S., Bouicher, I. A. D., et al. Toxic megacolon in 55 cases I., Gastroenterology, 1969, 57, p. 68–82.

11. Goldman, L., Ausiello, D. Cecil Medicine. 23^rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.

12. Su, C., Lichtenstein, G. R. Ulcerative colitis. In: Feldman, M., Friedman, L. S., Brandt, L. J., Sleisenger, M. H. Sleisenger & Fortran Gastrointestinal and Liver Disease. 8^th ed. Philadelphia, Pa: Saunders Elsevier; 2006: chap 109.

13. Marrero, F. Severe complications of inflammatory bowel disease. Med. Clin. North Am., 2008; 92: 671–686.