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Colite tóxica e megacólon tóxico

Last reviewed: 16 Aug 2025
Last updated: 29 Jul 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • febre/calafrios
  • taquicardia
  • alterações do estado mental
  • hipotensão
  • distensão abdominal
Full details

Other diagnostic factors

  • diarreia
  • dor abdominal
  • desconforto abdominal
Full details

Risk factors

  • colite ulcerativa
  • Colite de Crohn
  • colite pseudomembranosa
  • colite infecciosa
  • vírus da imunodeficiência humana (HIV)/síndrome de imunodeficiência adquirida (AIDS)/imunossupressão
  • descontinuação de medicamentos para tratamento da doença inflamatória intestinal
  • agentes antimotilidade
  • imunossupressão quimioterápica/química
  • anormalidades eletrolíticas
Full details

Diagnostic tests

1st tests to order

  • Hemograma completo
  • eletrólitos séricos
  • níveis de albumina sérica
  • ácido lático sérico
  • estudos de fezes
  • tomografia computadorizada (TC) de abdome/pelve
  • radiografia abdominal
  • radiografia torácica
Full details

Tests to consider

  • proteína C-reativa
  • velocidade de hemossedimentação (VHS)
  • hemoculturas
  • sigmoidoscopia
  • biópsia retal
  • espécime cirúrgico
Full details

Treatment algorithm

ACUTE

todos os pacientes

Contributors

Authors

Jan Rakinic, MD

Chief

Colorectal Surgery

Department of Surgery

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JR is the President of the American Board of Colon and Rectal Surgery.

V. Prasad Poola, MBBS, FACS, FASCRS

Associate Professor of Surgery

Department of Surgery

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

VPP declares that he has no competing interests.

Acknowledgements

Dr Jan Rakinic and Dr V. Prasad Poola would like to gratefully acknowledge Dr Scott A. Strong, Dr Mukta V. Krane, and Dr Alessandro Fichera, previous contributors to this topic.

Disclosures

SAS, MVK, and AF declare that they have no competing interests.

Peer reviewers

Sharon Stein, MD

Assistant Professor of Surgery

Division of Colon and Rectal Surgery

University Hospital Case Medical Center

Cleveland

OH

Disclosures

SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

James Wheeler, MB, BCh, MD, FRCS

Consultant

Colorectal Surgeon

Addenbrookes Hospital

Cambridge

UK

Disclosures

JW declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Rubin DT, Ananthakrishnan AN, Siegel CA, et al. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019 Mar;114(3):384-413.Full text  Abstract

McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19;66(7):987-94.Full text  Abstract

Kelly CR, Fischer M, Allegretti JR, et al. ACG clinical guidelines: prevention, diagnosis, and treatment of Clostridioides difficile infections. Am J Gastroenterol. 2021 Jun 1;116(6):1124-47.Full text  Abstract

Lightner AL, Vogel JD, Carmichael JC, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the surgical management of Crohn's disease. Dis Colon Rectum. 2020 Aug;63(8):1028-52.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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