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Revista Colombiana de Gastroenterologia

Print version ISSN 0120-9957

Abstract

SIADO, Sergio Andrés; JIMENEZ, Héctor Conrado  and  MARTINEZ MONTALVO., Carlos Mauricio. Megacolon toxic of idiophatic origin: case report. Rev Col Gastroenterol [online]. 2018, vol.33, n.2, pp.166-171. ISSN 0120-9957.  http://dx.doi.org/10.22516/25007440.256.

Toxic megacolon is a pathology whose mortality rate is over 80%. A progressive inflammatory process compromises the colon wall, and secondary dilation of the intestinal lumen occurs due to inflammatory or infectious processes. Its clinical presentation is bizarre. but the basic pillars for management are opportune diagnosis and adequate medical management with antibiotics, water resuscitation, and metabolic correction. If necessary, effective surgical management can prevent the development of complications that worsen the disease and the prognosis of a patient. In this article we present the case of a patient who died after developing septic shock secondary to toxic megacolon. Cholangitis grade III was suspected, but discarded after ultrasonography, and this resulted in generated distortions in approach and initial management. Due to clinical deterioration and abdominal distension, the patient underwent diagnostic laparoscopy which revealed severe ischemic compromise of the entire colon but without involvement of the small intestine. For this reason, a total colectomy was performed. The pathology report and clinical history ruled out ulcerative colitis or Crohn’s disease which confirmed the diagnosis of toxic megacolon. The patient had no risk factors for the development of pseudomembranous colitis. We conclude that this was a case of idiopathic toxic megacolon.

Keywords : Toxic megacolon; infectious colitis; acute abdomen; colitis; cholangitis; sepsis.

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