Q: 28 year old male with previous history of ulcerative colitis is admitted to ICU with exacerbation of his disease upto fulminant level. Radiological workup showed colonic dilatation of 5.5 cm. Beside regular management with IVF, NPO, naso-gastric tube decompression, antibiotics, steroids and surgical evaluation - which one simple non-pharmacological maneuver at bedside may help?


 Answer: Intermittent rolling maneuvers every couple of hours or the knee-elbow position may help to redistribute gas in the colon and may help in promoting decompression.



References:

1. 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. 

2. Panos MZ, Wood MJ, Asquith P. Toxic megacolon: the knee-elbow position relieves bowel distension. Gut 1993; 34:1726.