Division of Gastroenterology and Hepatology, Department of Medicine, Virchow Hospital, Charité Medical School, Humboldt-University of Berlin, Germany.
Inflamm Bowel Dis. 2012 Mar;18(3):584-91. doi: 10.1002/ibd.21847.
Toxic megacolon represents a dreaded complication of mainly inflammatory or infectious conditions of the colon. It is most commonly associated with inflammatory bowel disease (IBD), i.e., ulcerative colitis or ileocolonic Crohn's disease. Lately, the epidemiology has shifted toward infectious causes, specifically due to an increase of Clostridium difficile-associated colitis possibly due to the extensive (ab)use of broad-spectrum antibiotics. Other important infectious etiologies include Salmonella, Shigella, Campylobacter, Cytomegalovirus (CMV), rotavirus, Aspergillus, and Entameba. Less frequently, toxic megacolon has been attributed to ischemic colitis, collagenous colitis, or obstructive colorectal cancer. Toxic colonic dilatation may also occur in hemolytic-uremic syndrome (HUS) caused by enterohemorrhagic or enteroaggregative Escherichia coli O157 (EHEC, EAEC, or EAHEC). The pathophysiological mechanisms leading to toxic colonic dilatation are incompletely understood. The main characteristics of toxic megacolon are signs of systemic toxicity and severe colonic distension. Diagnosis is made by clinical evaluation for systemic toxicity and imaging studies depicting colonic dilatation. Plain abdominal imaging is still the most established radiological instrument. However, computed tomography scanning and transabdominal intestinal ultrasound are promising alternatives that add additional information. Management of toxic megacolon is an interdisciplinary task that requires close interaction of gastroenterologists and surgeons from the very beginning. The optimal timing of surgery for toxic megacolon can be challenging. Here we review the latest data on the pathogenesis, clinical presentation, laboratory, and imaging modalities and provide algorithms for an evidence-based diagnostic and therapeutic approach.
中毒性巨结肠是一种主要由结肠炎症或感染性疾病引起的严重并发症。它最常与炎症性肠病（IBD）相关，即溃疡性结肠炎或回肠结肠克罗恩病。最近，感染性病因的流行病学发生了转变，特别是由于艰难梭菌相关性结肠炎的增加，可能是由于广泛（滥用）使用广谱抗生素。其他重要的感染性病因包括沙门氏菌、志贺氏菌、弯曲杆菌、巨细胞病毒（CMV）、轮状病毒、曲霉菌和内阿米巴。较少见的情况下，中毒性巨结肠归因于缺血性结肠炎、胶原性结肠炎或阻塞性结直肠癌。溶血性尿毒症综合征（HUS）也可能导致中毒性结肠扩张，由产肠毒性或聚集性大肠杆菌 O157（EHEC、EAEC 或 EAHEC）引起。导致中毒性结肠扩张的病理生理机制尚未完全清楚。中毒性巨结肠的主要特征是全身毒性和严重结肠扩张的迹象。诊断通过全身毒性的临床评估和描绘结肠扩张的影像学研究进行。腹部平片仍然是最常用的影像学仪器。然而，计算机断层扫描和经腹肠道超声是有前途的替代方法，可以提供额外的信息。中毒性巨结肠的管理是一项跨学科任务，需要从一开始就密切配合胃肠病学家和外科医生。中毒性巨结肠手术的最佳时机可能具有挑战性。在这里，我们回顾了关于发病机制、临床表现、实验室和影像学模式的最新数据，并提供了基于证据的诊断和治疗方法的算法。
