Life-threatening complications of IBD: How to handle fulminant colitis and toxic megacolon: Clinical features, key diagnostic tests, and treatment options

R. B. Stein*, S. B. Hanauer

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

Fulminant colitis and toxic megacolon are life-threatening complications of acute inflammatory bowel disease (IBD) that require aggressive therapy. Predisposing factors include dosage reduction of medications for IBD; enteric infections; and certain drugs, including narcotics, antidiarrheals, and anticholinergics. Diagnostic features include diarrhea (more than six stools per day); hematochezia; fever; abdominal tenderness, distention, or rebound tenderness; increased C-reactive protein concentrations; elevated erythrocyte sedimentation rate; and hypokalemia. Diagnosis is secured with abdominal radiography and limited flexible sigmoidoscopy (with minimal air insufflation). Medical treatment is based largely on corticosteroids (hydrocortisone or methylprednisolone) and cyclosporine. Absolute indications for colectomy include perforation, massive hemorrhage, and clinical deterioration despite intensive medical therapy.

Original languageEnglish (US)
Pages (from-to)518-525
Number of pages8
JournalJournal of Critical Illness
Volume13
Issue number8
StatePublished - Jan 1 1998

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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