toxicmegacolonppt课件.ppt

Clinical features and diagnosis The clinical features of pseudo-obstruction are typical of mechanical obstruction; abdominal distention, pain, nausea and/or vomiting Physical examination reveals a very distended, tympanitic, non-tender abdomen with high pitched tinkling, reduced or absent bowel sounds Diagnosis can be confirmed by demonstration of colonic dilation with an abdominal X-ray and exclusion of mechanical obstruction by CT and enteroscopy Case 3 Symptomatology A 78-year-old female complaint of periumbilical pain with nausea and vomiting for about one month Plain abdominal film showed colonic distension Abdominal CT examination and enteroscopy confirmed that there was no obstruction Clinical diagnosis Intestinal pseudo-obstruction Management of Toxic Megacolon General Intravenous fluid support Correct electrolyte abnormalities Complete bowel rest Discontinue anticholinergics and narcotics Rule out infectious etiology Decompression Rectal tube Nasogastric or long nasointestinal tube Repositioning maneuvers Management of Toxic Megacolon Medical care Specific treatment for infections Intravenous corticosteroids for inflammatory bowel disease Broad spectrum antibiotics Radiology Frequent assessment with plain films Computed tomographic scanning may aid in management Surgical intervention Failed medical care Progressive toxicity or dilation Signs of perforation Summary Toxic megacolon is mainly caused by inflammatory bowel disease and characterized by total or segmental nonobstructive colonic distension of at least 6 cm, associated with systemic toxicity Diagnostic approach Clinical criteria Imaging findings References Autenrieth D M, Baumgart D C. Toxic megacolon [J]. Inflamm Bowel Dis, 2012, 18 (3) : 584-591 Gan S I, Beck P L. A new look at toxic megacolon: an update and rev