Case Report
Copyright ©2010 Baishideng. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2010; 2(8): 293-297
Published online Aug 16, 2010. doi: 10.4253/wjge.v2.i8.293
Toxic megacolon associated Clostridium difficile colitis
Leena Sayedy, Darshan Kothari, Robert J Richards
Leena Sayedy, Darshan Kothari, Robert J Richards, Division of Gastroenterology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY 11794-8160, United States
Author contributions: Sayedy L, Kothari D, and Richards RJ were responsible for the content, accuracy and writing of this article.
Correspondence to: Robert J Richards, Associate Professor of Clinical Medicine, Division of Gastroenterology, Department of Medicine, Stony Brook University School of Medicine, HSC, Level 17, Room 063, Stony Brook, NY 11794, United States. rrichards@notes.cc.sunysb.edu
Telephone: +1-631-4442119 Fax: +1-631-4448886
Received: May 4, 2010
Revised: June 23, 2010
Accepted: June 30, 2010
Published online: August 16, 2010
Abstract

Toxic megacolon is a severe complication of Clostridium difficile (C. difficile) colitis. As the prevalence of C. difficile colitis increases and treatments become more refractory, clinicians will encounter more patients with C. difficile associated toxic megacolon in the future. Here, we review a case of toxic megacolon secondary to C. difficile colitis and review the current literature on diagnosis and management. We identify both clinical and radiologic criteria for diagnosis and discuss both medical and surgical options for management. Ultimately, we recommend using the Jalen criteria in conjunction with daily abdominal radiographs to help establish the diagnosis of toxic megacolon and to make appropriate treatment recommendations. Aggressive medical management using supportive measures and antibiotics should remain the mainstay of treatment. Surgical intervention should be considered if the patient does not clinically improve within 2-3 d of initial treatment.

Keywords: Toxic megacolon; Clostridium difficile; Colitis; Diarrhea; Surgery; Colon; Antibiotics; Metronidazole; Vancomycin