Editing Severe colitis (section)

== '''Management of toxic megacolon''' ==

* Initial supportive medical therapy as above, which can avoid an operation in 50% of patients
* Close multidisciplinary manage with experienced gastroenterologist
* Timing of surgery varies with underlying aetiology
* Absolute indications for surgery at any time:
** Frank intra-peritoneal haemorrhage
** Life-threatening bleeding or increasing transfusion requirements
** Worsening systemic toxicity
** Worsening colonic dilatation
* IBD
** Hydrocortisone 100mg QID IV. If deterioration, re-image looking for complications.
*** After 48-72 hours, if no improvement, switch to infliximab or upadacitinib or cyclosporine (cyclocporine is only evidence-based in UC and should only be given to those who cannot have infliximab)
*** Surgeons usually recommend surgery if no improvement in colon after 24-48 hours
** If no improvement after second-line therapy for 72 hours, recommend surgery
* C diff
** See separate topic

[[Category:Colorectal]]