Kobayasi S, Mendes E F, Rodrigues M A, Franco M F
Department of Surgery, Universidade Estadual Paulista, São Paulo, Brazil.
Br J Surg. 1992 Nov;79(11):1202-3. doi: 10.1002/bjs.1800791135.
Toxic megacolon occurs in colitis of differing aetiology. This report describes 15 patients with chagasic megacolon with this complication. The clinical signs and symptoms in all patients were pain and progressive abdominal distension accompanied by fever, severe toxaemia and shock. Seven patients developed this clinical pattern after manual removal of faeces. The remaining patients had pain and abdominal distension followed by signs of severe toxaemia when first examined. Nine patients underwent total colectomy with ileostomy (one death), four partial colectomy (all died) and two received medical treatment (both died). At autopsy, three of the four patients undergoing partial colectomy had residual colitis and enteritis. The surgical procedure of choice for this complication of chagasic megacolon is total colectomy.
中毒性巨结肠可见于不同病因的结肠炎。本报告描述了15例患有恰加斯病巨结肠并伴有该并发症的患者。所有患者的临床体征和症状为疼痛、进行性腹胀，伴有发热、严重毒血症和休克。7例患者在人工排便后出现这种临床症状。其余患者初诊时表现为疼痛和腹胀，随后出现严重毒血症体征。9例行全结肠切除加回肠造口术（1例死亡），4例行部分结肠切除术（均死亡），2例接受内科治疗（均死亡）。尸检时，4例行部分结肠切除术的患者中有3例残留结肠炎和小肠炎。恰加斯病巨结肠这一并发症的首选手术方式是全结肠切除术。
