De la Torre-León G, Castro-Hess BA, Altamirano-Caliano SA

Language: Spanish
References: 12
Page: 104-109
PDF size: 261.02 Kb.

ABSTRACT

Introduction: Toxic megacolon is described as total or segmentary colonic distension greater than six centimeters in diameter, associated with acute colitis and systemic symptoms. Multiple inflammatory processes of the colon can trigger it, and its incidence depends on the cause. Early diagnosis and timely treatment are essential due to its high morbidity and mortality. Clinical case: 38-year-old female with a diagnosis of cerebral venous thrombosis and probable neuroinfection upon admission. She was treated with antibiotics for 12 days, presenting diarrheic evacuations and fever, with a probable diagnosis of pseudomembranous colitis. She was evaluated by infectology, adding vancomycin; however, she had a torpid evolution with an increasing leukocyte count, abdominal distension and absence of evacuations. Tomographic and clinical data suggested toxic megacolon; we decided to perform a surgical intervention, finding dilated colon in all its length up to 13 cm at the level of the cecum and ascending colon, as well as segmental necrosis, for which subtotal colectomy with terminal ileostomy was done. Conclusion: The high mortality rate of toxic megacolon requires an early recognition of signs, symptoms and history, that will lead to a timely diagnosis and treatment, implementing an aggressive surgical behavior that plays a key role in survival.

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