Q: 54 years old male with known ulcerative colitis is admitted to ICU with megacolon. Intravenous (IV) steroid is started. This may increase the risk of bowel perforation.
A) True
B) False
Answer: B
There are three major objectives for toxic megacolon management in inflammatory bowel disease (IBD)
1. reduce inflammation
2. restore colonic motility
3. decrease the risk of perforation
Almost half of the patients recover with supportive and medical management.
The mainstay of treatment is bowel rest, nasogastric tube (NGT), Intravenous fluid (IVF), electrolyte repletion, and total parenteral nutrition (TPN). Less emphasized is the early initiation of enteral feed if patients can tolerate it as it expedites mucosal healing and motility. Non-pharmacologic interventions such as periodic rolling maneuvers and the knee-elbow position have been described in the past and may help.
So far there is no evidence that IV glucocorticoids increase the risk of perforation.
#surgical-critical-care
References:
1. Norland CC, Kirsner JB. Toxic dilatation of colon (toxic megacolon): etiology, treatment and prognosis in 42 patients. Medicine (Baltimore) 1969; 48:229.
2. Autenrieth DM, Baumgart DC. Toxic megacolon. Inflamm Bowel Dis 2012; 18:584.
3. Present DH, Wolfson D, Gelernt IM, et al. Medical decompression of toxic megacolon by "rolling". A new technique of decompression with favorable long-term follow-up. J Clin Gastroenterol 1988; 10:485.
4. Panos MZ, Wood MJ, Asquith P. Toxic megacolon: the knee-elbow position relieves bowel distension. Gut 1993; 34:1726.
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