症例 challenge · Gastroenterology / Colorectal surgery / Critical care · teaching

Toxic Megacolon — Management Pathway · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

← View the full flowchartBased on Jalan / ACG

Case #1Gastroenterology / Colorectal surgery / Critical care

📋 Case data

Surgery needed?Perforation/progressive dilation/no improvement at 24–72 h/worsening

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Surgery needed?

Perforation / progressive dilation / no improvement on medical therapy?

💡 Non-obstructive colonic dilation ≥6 cm + systemic toxicity. Causes: IBD (UC > Crohn's), infectious colitis (increasingly C. diff; Salmonella/Shigella/CMV/amoebiasis), ischemia. Jalan criteria: 1) imaging colonic dilation >6 cm (typically transverse colon, highest perforation risk); 2) ≥3 of: fever >38.6°C, HR >120, WBC >10.5×10⁹, anemia; 3) ≥1 of: dehydration/altered mentation/electrolyte disturbance/hypotension. Colonoscopy is contraindicated (perforation risk); a limited sigmoidoscopy may define the cause + check C. diff; daily abdominal X-ray to measure diameter.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.