title: Is really megacolon a contraindication to infliximab in Crohn's disease?
abstract: 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.
authors.affiliation: DIBIMIS, Ospedali Riuniti Villa Sofia- Vincenzo Cervello, Division of Internal Medicine, Palermo.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Sinagra
authors.affiliation: DIBIMIS, Ospedali Riuniti Villa Sofia- Vincenzo Cervello, Division of Internal Medicine, Palermo.
authors.forename: Ambrogio
authors.initials: A
authors.lastname: Orlando
authors.affiliation: DIBIMIS, Ospedali Riuniti Villa Sofia- Vincenzo Cervello, Division of Internal Medicine, Palermo.
authors.forename: Sara
authors.initials: S
authors.lastname: Renna
authors.forename: Valeria
authors.initials: V
authors.lastname: Criscuoli
authors.affiliation: Radiology Unit, Palermo.
authors.forename: Francesco
authors.initials: F
authors.lastname: La Seta
authors.affiliation: DIBIMIS, Ospedali Riuniti Villa Sofia- Vincenzo Cervello, Division of Internal Medicine, Palermo.
authors.forename: Mirko
authors.initials: M
authors.lastname: Olivo
authors.affiliation: DIBIMIS, Ospedali Riuniti Villa Sofia- Vincenzo Cervello, Division of Internal Medicine, Palermo.
authors.forename: Marco
authors.initials: M
authors.lastname: Ciofalo
authors.affiliation: DIBIMEF, Sezione di Scienze Radiologiche, AOUP Paolo Giaccone, Palermo.
authors.forename: Mario
authors.initials: M
authors.lastname: Cottone
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008532:Megacolon, Toxic / Q000209:etiology*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D000069285:Infliximab