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Crohn's disease of the colon. III. Toxic dilatation of the colon in Crohn's colitis.
Am J Gastroenterol. 1975 Feb; 63(2):117-28.AJ

Abstract

In a group of 160 patients with Crohn's disease involving the colon, there were seven patients with toxic dilatation, four with granulomatous colitis and three with ileocolitis, all successfully treated without mortality. This complications is more common than previously recognized in Crohn's colitis. In Crohn's disease, toxic dilatation is less likely to proceed to perforation of the bowel, because of the nature of the pathology and is more likely to respond to conservative measures: intubation, with decompression, corticotropin, steroids and high-dose antibiotic administration. Although patients do recover from this life-threatening complication with conservative management, the majority of patients, if not all, will ultimately come to surgical excision of the colon. If surgery is mandatory, it should be carried out early, rather than late, in the patient who is failing to respond to medical therapy, certainly before the development of perforation, massive hemorrhage, or gram negative sepsis with shock. The surgical therapy will depend upon the state of the bowel at laparotomy. Thus, an intact bowel in a young patient, would favor subtotal colectomy or proctocolectomy; a sealed perforation, a diverting ileostomy with skin level colostomy decompression as suggested by Turnbull and a free perforation, the minimum adequate procedure which will tide the patient over the early postoperative period. Diverting ileostomy alone has been effective in two of our patients but should be avoided in ulcerative colitis. The critically ill patient with the ominous finding of "disintegrating colitis" and multiple leaks, will require nothing less than total radical excision of the diseased bowel in the hope of immediate salvage.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

165716

Citation

Greenstein, A J., et al. "Crohn's Disease of the Colon. III. Toxic Dilatation of the Colon in Crohn's Colitis." The American Journal of Gastroenterology, vol. 63, no. 2, 1975, pp. 117-28.
Greenstein AJ, Kark AE, Dreiling DA. Crohn's disease of the colon. III. Toxic dilatation of the colon in Crohn's colitis. Am J Gastroenterol. 1975;63(2):117-28.
Greenstein, A. J., Kark, A. E., & Dreiling, D. A. (1975). Crohn's disease of the colon. III. Toxic dilatation of the colon in Crohn's colitis. The American Journal of Gastroenterology, 63(2), 117-28.
Greenstein AJ, Kark AE, Dreiling DA. Crohn's Disease of the Colon. III. Toxic Dilatation of the Colon in Crohn's Colitis. Am J Gastroenterol. 1975;63(2):117-28. PubMed PMID: 165716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Crohn's disease of the colon. III. Toxic dilatation of the colon in Crohn's colitis. AU - Greenstein,A J, AU - Kark,A E, AU - Dreiling,D A, PY - 1975/2/1/pubmed PY - 1975/2/1/medline PY - 1975/2/1/entrez SP - 117 EP - 28 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 63 IS - 2 N2 - In a group of 160 patients with Crohn's disease involving the colon, there were seven patients with toxic dilatation, four with granulomatous colitis and three with ileocolitis, all successfully treated without mortality. This complications is more common than previously recognized in Crohn's colitis. In Crohn's disease, toxic dilatation is less likely to proceed to perforation of the bowel, because of the nature of the pathology and is more likely to respond to conservative measures: intubation, with decompression, corticotropin, steroids and high-dose antibiotic administration. Although patients do recover from this life-threatening complication with conservative management, the majority of patients, if not all, will ultimately come to surgical excision of the colon. If surgery is mandatory, it should be carried out early, rather than late, in the patient who is failing to respond to medical therapy, certainly before the development of perforation, massive hemorrhage, or gram negative sepsis with shock. The surgical therapy will depend upon the state of the bowel at laparotomy. Thus, an intact bowel in a young patient, would favor subtotal colectomy or proctocolectomy; a sealed perforation, a diverting ileostomy with skin level colostomy decompression as suggested by Turnbull and a free perforation, the minimum adequate procedure which will tide the patient over the early postoperative period. Diverting ileostomy alone has been effective in two of our patients but should be avoided in ulcerative colitis. The critically ill patient with the ominous finding of "disintegrating colitis" and multiple leaks, will require nothing less than total radical excision of the diseased bowel in the hope of immediate salvage. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/165716/Crohn's_disease_of_the_colon__III__Toxic_dilatation_of_the_colon_in_Crohn's_colitis_ L2 - https://www.diseaseinfosearch.org/result/2013 DB - PRIME DP - Unbound Medicine ER -