Is really megacolon a contraindication to infliximab in Crohn's disease?

• Published in: Acta gastro-enterologica belgica Vol. 76; no. 4; p. 442
• Main Authors: Sinagra, Emanuele, Orlando, Ambrogio, Renna, Sara, Criscuoli, Valeria, La Seta, Francesco, Olivo, Mirko, Ciofalo, Marco, Cottone, Mario
• Format: Journal Article
• Language: English
• Published: Belgium 01.12.2013
• Subjects: Adolescent; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibodies, Monoclonal - therapeutic use; Crohn Disease - complications; Crohn Disease - drug therapy; Female; Follow-Up Studies; Humans; Infliximab; Megacolon, Toxic - etiology
• ISSN: 1784-3227

Toxic megacolon (TM) is a rare complication of severe ulcerative colitis (UC) and colonic Crohn's disease (CD), defined as a clinical syndrome accompanied by radiographic evidence of colonic dilatation that in many cases must be treated aggressively with surgical intervention (1). We report two cases of steroid and antibiotic-refractory fulminant Crohn's colitis, complicated by toxic megacolon, who were successfully treated with infliximab (IFX), thus avoiding surgical intervention. Although there are no well defined recommendation about the correct timing of colectomy in CD-associated TM, and despite the fact that it may be imprudent to advocate delaying surgery in favour of anti-tumor necrosis (anti-TNF) factor therapy in these cases, we think that a medical "rescue therapy" can be considered in a subset of patients with stable clinical condition during corticosteroid treatment.