Document Detail


Toxic megacolon in patients with severe acute colitis: computed tomographic features.
MedLine Citation:
PMID:  22040786     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: The objective of the study was to evaluate computed tomography (CT) in the differential diagnosis of patients with toxic megacolon (TM) complicating severe acute colitis (SAC) and patients with SAC but no TM.
MATERIALS AND METHODS: We identified 16 patients who presented clinically complicated SAC and CT examination before surgery. The CT scans of these patients were retrospectively evaluated in consensus by two abdominal radiologists blinded to the clinical and pathological results for CT findings of SAC, i.e., diffuse colonic wall thickening, submucosal edema, pericolonic fat stranding and ascites, and CT findings of TM reported in the literature, i.e., segmental colonic wall thinning, air-filled colonic distension over 6 cm with abnormal haustral pattern, nodular pseudopolyps and associated small bowel distension. Fisher's Exact Test was used for all statistical analyses.
RESULTS: Segmental colonic wall thinning with abnormal haustral pattern was noted in TM only (P=.001). As compared to patients with SAC but no TM as a complication, patients with TM showed statistically more frequent air-filled colonic distension over 6 cm (P=.001) and nodular pseudopolyps (P=.001). Diffuse colonic wall thickening (P=.036) and submucosal edema (P=.036) were more present in cases of uncomplicated SAC. Pericolonic fat stranding (P=.12), ascites (P=.6), and small bowel and gastric distension (P=1) were not distinctive criteria.
CONCLUSION: Computed tomography is useful in distinguishing patients with TM from patients with SAC but no TM as a complication. The association of air-filled colonic distension >6 cm, abnormal haustral pattern and segmental colonic parietal thinning seems pathognomonic of TM and should lead to rapid surgery.
Authors:
Véronique Moulin; Perrine Dellon; Olivia Laurent; Sébastien Aubry; Jean Lubrano; Eric Delabrousse
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical imaging     Volume:  35     ISSN:  1873-4499     ISO Abbreviation:  Clin Imaging     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8911831     Medline TA:  Clin Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Radiology, Besançon University Hospital, 3 bvd Flelming, F-25030 Besançon, France.
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