From the Guidelines
An abdominal X-ray is recommended as the initial imaging study for patients admitted with acute severe colitis to detect toxic megacolon, as stated in the ECCO-ESGAR guideline 1. This imaging study should be performed promptly upon admission to assess for colonic dilation, which is a potentially life-threatening complication. The X-ray can reveal colonic distension (diameter >6 cm indicates toxic megacolon), mucosal islands, and loss of haustrations. It may also detect free air if perforation has occurred. The patient should be positioned supine for the initial film, with an upright or lateral decubitus view if perforation is suspected. No specific patient preparation is required, making it suitable for acutely ill patients.
While the X-ray provides valuable initial information, it should be complemented by laboratory tests (CBC, CRP, electrolytes, albumin) and stool studies to assess infection. According to the British Society of Gastroenterology consensus guidelines 1, daily monitoring should include senior gastroenterology review, laboratory tests, and imaging, with surgical review if complications are suspected. CT imaging may be needed if severe complications, notably perforation, are suspected, as it is preferable to abdominal X-ray in such cases 1. The abdominal X-ray serves as a baseline for monitoring disease progression during treatment and helps guide management decisions, including the potential need for surgical intervention if toxic megacolon or perforation is present.
Some key points to consider when using abdominal X-ray in acute severe colitis include:
- Prompt performance upon admission to assess for toxic megacolon
- Supine positioning for the initial film, with upright or lateral decubitus view if perforation is suspected
- No specific patient preparation required
- Complementation with laboratory tests and stool studies to assess infection
- Potential need for CT imaging if complications are suspected
- Use as a baseline for monitoring disease progression and guiding management decisions.
From the Research
Abdominal X-ray on Admission for Acute Severe Colitis
- The abdominal X-ray is a crucial diagnostic procedure for toxic megacolon, a severe complication of inflammatory bowel diseases, as stated in 2.
- The X-ray helps to confirm the diagnosis of toxic megacolon if the diameter of colonic distension exceeds 60 mm, as mentioned in 2.
- In the management of severe acute colitis, plain abdominal X-ray is used to monitor the patient's condition, along with other tests such as full blood count, serum albumin, and C reactive protein, as described in 3.
- Abdominal X-ray is essential in detecting any evidence of colonic dilatation, which is an absolute indication for colectomy, as stated in 3.
- While the provided studies emphasize the importance of abdominal X-ray in diagnosing and managing toxic megacolon and severe acute colitis, they do not specifically discuss the role of abdominal X-ray on admission for acute severe colitis, except for its use in monitoring and diagnosis, as mentioned in 3, 4, and 5.