From the Guidelines
Treatment for a distended and collapsed colon should prioritize addressing the underlying cause, with aggressive medical therapy and early surgical intervention in cases of severe complications or lack of improvement, as indicated by the most recent guidelines 1.
Key Considerations
- The management of toxic megacolon, a severe complication of colonic inflammation, requires coordination between medical and surgical services to avoid colectomy and reduce mortality rates 1.
- Medical treatment should be carried out aggressively and in a timely fashion, including the use of steroids, fluids, and transfusions, with frequent reevaluations to assess the patient's condition 1.
- Indications for urgent surgery include free perforation, massive hemorrhage, increasing transfusion requirements, increasing signs of toxicity, and progression of colonic dilatation 1.
Treatment Approach
- For mild cases, conservative management may be sufficient, but for more severe cases, immediate medical attention is necessary, with potential interventions including decompression procedures, such as nasogastric tube placement or colonoscopic decompression, or even surgery in cases of volvulus or severe obstruction 1.
- The choice of surgical approach, whether open or laparoscopic, depends on the patient's hemodynamic stability and signs of sepsis, with laparoscopic approaches potentially reducing length of stay and morbidity in hemodynamically stable patients 1.
- In cases of severe Clostridioides difficile infection (CDI), antibiotic therapy, such as vancomycin or fidaxomicin, may be indicated, with fecal microbiota transplantation (FMT) or coadjutant treatment with monoclonal antibodies (bezlotoxumab) considered for patients with multiple recurrences or severe CDI 1.
Prioritizing Outcomes
- The primary goal of treatment is to reduce morbidity, mortality, and improve quality of life, with a focus on addressing the underlying cause of the distended and collapsed colon, rather than just managing symptoms 1.
- By prioritizing aggressive medical therapy and early surgical intervention, healthcare providers can reduce the risk of severe complications and improve patient outcomes, as supported by the most recent and highest quality studies 1.
From the Research
Treatment of Distended and Collapsed Colon
- The treatment of a distended and collapsed colon depends on the underlying cause of the condition.
- For patients with intestinal obstruction, management includes intravenous fluid resuscitation, nasogastric decompression, and bowel rest 2.
- In cases where the obstruction is caused by a complication of colonoscopy, a second colonoscopy may be performed to decompress the colon by suctioning out the entrapped air 3.
- If the patient shows signs of vascular compromise or perforation, or if nonoperative management is unsuccessful, surgical intervention may be necessary 2.
- Antibiotic coverage against gram-negative organisms and anaerobes should be provided to patients with fever and leukocytosis 2.
- The use of laparoscopic techniques can be applied in abdominal surgery for the management of complications such as bleeding, obstruction, and perforation in patients with colon cancer 4.
Diagnosis and Management
- A definitive diagnosis of the cause of perforation is not necessary before operation, and treatment generally includes intravenous antibiotics and fluid resuscitation 5.
- Laboratory evaluation should include a complete blood count, metabolic panel, and serum lactate level, and imaging with abdominal radiography or computed tomography can confirm the diagnosis and assist in decision making for therapeutic planning 2.
- The Boston Bowel Preparation Scale (BBPS) is a validated and reliable scale for evaluation of cleansing, and documentation of preparation quality is essential to guide the practitioner in timing of follow-up examination 6.