WordNet

of or relating to or caused by a toxin or poison; "suffering from exposure to toxic substances"
an abnormal enlargement of the colon; can be congenital (as in Hirschsprungs disease) or acquired (as when children refuse to defecate)

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毒性の,有毒な / 毒による

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/01/16 20:20:30」(JST)

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Toxic megacolon (megacolon toxicum) is an acute form of colonic distension.^[1] It is characterized by a very dilated colon (megacolon), accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock.

Toxic megacolon is usually a complication of inflammatory bowel disease, such as ulcerative colitis and, more rarely, Crohn's disease, and of some infections of the colon, including Clostridium difficile infections, which have led to pseudomembranous colitis. Other forms of megacolon exist and can be congenital (present since birth, such as Hirschsprung's disease). Also, it can be caused by Entamoeba histolytica and Shigella.

Signs and symptoms

Abdominal pain
Abdominal bloating
Abdominal tenderness
Fever
Tachycardia (rapid heart rate)
Dehydration

There may be signs of septic shock. A physical examination reveals abdominal tenderness and possible loss of bowel sounds. An abdominal radiography shows colonic dilation. White blood cell count is usually elevated. Severe sepsis may present with hypothermia or leukopenia.

Treatment

Toxic megacolon in a patient with ulcerative colitis: The patient subsequently underwent a colectomy.

The objective of treatment is to decompress the bowel and to prevent swallowed air from further distending the bowel. If decompression is not achieved or the patient does not improve within 24 hours, a colectomy (surgical removal of all or part of the colon) is indicated. When surgery is required the recommended procedure is a subtotal colectomy with end ileostomy.^[2] Fluid and electrolyte replacement help to prevent dehydration and shock. Use of corticosteroids may be indicated to suppress the inflammatory reaction in the colon if megacolon has resulted from active inflammatory bowel disease. Antibiotics may be given to prevent sepsis.^[3]

Prognosis

If the condition does not improve, the risk of death is significant. In case of poor response to conservative therapy, a colectomy is usually required.^[4]

Complications

A pathological specimen showing toxic megacolon

Perforation of the colon^[5]
Sepsis
Shock

Emergency action may be required if severe abdominal pain develops, particularly if it is accompanied by fever, rapid heart rate, tenderness when the abdomen is pressed, bloody diarrhea, frequent diarrhea, or painful bowel movements.

Colonoscopy is contraindicated, as it may rupture the dilated colon resulting in peritonitis and septic shock.

Footnotes

^ "Toxic megacolon" at Dorland's Medical Dictionary
^ Seltman, AK (December 2012). "Surgical Management of Clostridium difficile Colitis". Clinics in Colon and Rectal Surgery. 25 (4): 204–9. doi:10.1055/s-0032-1329390. PMC 3577611. PMID 24294121.
^ Autenrieth, DM; Baumgart, DC (August 2011). "Toxic megacolon". Inflammatory Bowel Diseases. 18: 584–91. doi:10.1002/ibd.21847. PMID 22009735.
^ Benchimol, EI; Turner, D; Mann, EH; Thomas, KE; et al. (June 2008). "Toxic megacolon in children with inflammatory bowel disease: Clinical and radiographic characteristics". The American Journal of Gastroenterology. 103 (6): 1524–31. doi:10.1111/j.1572-0241.2008.01807.x. PMID 18510624.
^ Panos, MZ; Wood, MJ; Asquith, P (December 1993). "Toxic megacolon: The knee-elbow position relieves bowel distension". Gut. 34 (12): 1726–7. doi:10.1136/gut.34.12.1726. PMC 1374472. PMID 8282262.

References

This article incorporates text from the United States National Library of Medicine (Toxic megacolon), which is in the public domain.

UpToDate Contents

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1. 中毒性巨大結腸症 toxic megacolon
2. 急性偽性腸閉塞（オギルビー症候群） acute colonic pseudo obstruction ogilvies syndrome
3. 小児における下痢の評価 evaluation of diarrhea in children
4. 潰瘍性大腸炎の外科的マネージメント surgical management of ulcerative colitis
5. 成人における潰瘍性大腸炎の臨床症状、診断、および予後 clinical manifestations diagnosis and prognosis of ulcerative colitis in adults

English Journal

The roles of host and pathogen factors and the innate immune response in the pathogenesis of Clostridium difficile infection.

Sun X1, Hirota SA2.
Molecular immunology.Mol Immunol.2015 Feb;63(2):193-202. doi: 10.1016/j.molimm.2014.09.005. Epub 2014 Sep 18.
Clostridium difficile (C. difficile) is the most common cause of nosocomial antibiotic-associated diarrhea and the etiologic agent of pseudomembranous colitis. The clinical manifestation of C. difficile infection (CDI) is highly variable, from asymptomatic carriage, to mild self-limiting diarrhea, t
PMID 25242213

Risk Factors for Crohn's Disease of the Neo-Small Intestine in Ulcerative Colitis Patients with Total Proctocolectomy and Primary or Secondary Ileostomies.

Du P1, Sun C2, Ashburn J3, Wu X3, Philpott J3, Remzi F3, Shen B4.
Journal of Crohn's & colitis.J Crohns Colitis.2014 Dec 5. pii: jju014. [Epub ahead of print]
BACKGROUND: De novo Crohn's disease (CD) of neo-small intestine in ulcerative colitis (UC) patients after total proctocolectomy (TPC) is a new disease entity, which may persist even after a secondary diverting permanent ileostomy for pouch failure. We sought to compare outcomes of primary ileostomy
PMID 25518056

Toxic colitis with megacolon in a patient with malrotation.

Zwischenberger BA1, Vargas HD.
The American surgeon.Am Surg.2014 Dec;80(12):356-8.
PMID 25513909

Japanese Journal

中毒性巨大結腸症と麻痺性イレウスを合併した偽膜性腸炎の1例

青木貴哉,片岡幹統,曽義家,内藤咲貴子,竹内眞美,辻雄一郎,原田明日香,杉本弥子,羽山弥毅,山本圭,野中雅也,八木健二,藤原麻里,福澤誠克,川上浩平,河合隆,森安史典
日本消化器病學會雜誌 = The Japanese journal of gastro-enterology 109(8), 1386-1393, 2012-08-05
症例は60歳，男性．脳外科疾患術後に偽膜性腸炎を発症した．塩酸バンコマイシン（VCM）経口投与では改善乏しく，麻痺性イレウスと中毒性巨大結腸症を併発した．イレウス管からのVCM投与と内視鏡による洗浄，VCM撒布，そしてVCM注腸を繰り返したところ軽快した．偽膜性腸炎は，麻痺性イレウスや中毒性巨大結腸症を併発すると予後不良とされているが，それらを併発しながらも，内科的治療により軽快した1例を経験した …
NAID 10030962649

中毒性巨大結腸症の診断と治療 (炎症性腸疾患 : 病因解明と診断・治療の最新知見) -- (炎症性腸疾患の外科的治療)

板橋道朗,飯塚文瑛,白鳥敬子 [他]
日本臨床 70 (1015 増刊1), 457-461, 2012-02-00
NAID 40019202387

Toxic Megacolon Associated with Cytomegalovirus Infection in a Patient with Steroid-naïve Ulcerative Colitis

Inoue Ken,Wakabayashi Naoki,Fukumoto Kohei,Yamada Shinya,Bito Nobukatsu,Yoshida Naohisa,Katada Kazuhiro,Uchiyama Kazuhiko,Ishikawa Takeshi,Handa Osamu,Takagi Tomohisa,Konishi Hideyuki,Yagi Nobuaki,Kokura Satoshi,Kishimoto Mitsuo,Yanagisawa Akio,Naito Yuji
Internal Medicine 51(19), 2739-2743, 2012
… We herein present the case of a 57-year-old man with toxic megacolon associated with CMV colitis in corticosteroid-naïve ulcerative colitis (UC). …
NAID 130002062039

Related Pictures

★リンクテーブル★

リンク元	「中毒性巨大結腸症」「中毒性巨大結腸」
関連記事	「toxic」

「中毒性巨大結腸症」

Toxic megacolon
	Micrograph of pseudomembranous colitis, a cause of toxic megacolon. H&E stain.
Classification and external resources
Specialty	gastroenterology
ICD-10	K59.3
ICD-9-CM	556.9
DiseasesDB	27702
MedlinePlus	000248
eMedicine	med/1418 radio/702
MeSH	D008532
	[edit on Wikidata]

　　[★]

英: toxic megacolon
関: 巨大結腸症候群

病態

腸管の運動低下のために拡張をきたした病態。腹部波長間隔腸により膨隆し、腸管運動は減少、消失する(IMD.886)

病因

注腸検査、大腸内視鏡検査、抗コリン薬や麻薬の使用、電解質異常など(IMD.886)
炎症腸疾患(特に潰瘍性大腸炎)で合併しやすい。
重症の大腸炎で腸管運動を抑制する薬物の頻回の使用は禁忌(IMD.886)

治療

治療の禁忌

大腸内視鏡検査

ガスの注入により穿孔リスク

「中毒性巨大結腸」

　　[★] 中毒性巨大結腸症 toxic megacolon

関: 巨大結腸症候群

「toxic」

　　[★]

adj.

有毒な、毒性のある、中毒性の

関: intoxicated、poisonous、toxicity、venomous、virulence、virulent

[1] "Toxic megacolon" at Dorland's Medical Dictionary

[2] Seltman, AK (December 2012). "Surgical Management of Clostridium difficile Colitis". Clinics in Colon and Rectal Surgery. 25 (4): 204–9. doi:10.1055/s-0032-1329390. PMC 3577611. PMID 24294121.

[Autenrieth2011-3] Autenrieth, DM; Baumgart, DC (August 2011). "Toxic megacolon". Inflammatory Bowel Diseases. 18: 584–91. doi:10.1002/ibd.21847. PMID 22009735.

[4] Benchimol, EI; Turner, D; Mann, EH; Thomas, KE; et al. (June 2008). "Toxic megacolon in children with inflammatory bowel disease: Clinical and radiographic characteristics". The American Journal of Gastroenterology. 103 (6): 1524–31. doi:10.1111/j.1572-0241.2008.01807.x. PMID 18510624.

[pmid8282262-5] Panos, MZ; Wood, MJ; Asquith, P (December 1993). "Toxic megacolon: The knee-elbow position relieves bowel distension". Gut. 34 (12): 1726–7. doi:10.1136/gut.34.12.1726. PMC 1374472. PMID 8282262.

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案内

案内

toxic megacolon