Q: A 23-year-old male is admitted to the ICU with a flare-up of his ulcerative colitis. CT scan in ED is consistent with Toxic Megacolon. Surgical service wrote for serial KUBs. What's the importance of serial KUBs in Toxic Megacolon?
Answer: May determine the course of toxic megacolon
Although CT is preferred over KUB in toxic megacolon, it's not practical to perform it every few hours. Instead, following clinical signs of toxicity with serial KUBs may help to determine the course of the disease. A progressive increase in small bowel gas on abdominal films may help determine whether toxic megacolon is worsening or improving. As the name implies, signs of clinical toxicity highly correlate with severity of toxic megacolon, such as fever, heart rate, neutrophilic leukocytosis, anemia, dehydration, mental status change, electrolyte abnormalities, and hypotension.
Also, an increase in small-bowel gas on abdominal films, or a changing pattern such as multiple air-fluid levels, may be helpful. If serial KUBs indicate treatment failure along with clinical signs, CT should be considered. Ultrasound has also been used successfully alongside serial KUBs.
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References:
1. . Hokama A, Ohira T, Kishimoto K, et al. Impending megacolon: small bowel distension as a predictor of toxic megacolon in ulcerative colitis. Intern Emerg Med 2012; 7:487.
2. Arienti V, Campieri M, Boriani L, et al. Management of severe ulcerative colitis with the help of high resolution ultrasonography. Am J Gastroenterol 1996; 91:2163.
3. Moulin V, Dellon P, Laurent O, et al. Toxic megacolon in patients with severe acute colitis: computed tomographic features. Clin Imaging 2011; 35:431.
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