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Toxic megacolon

Toxic dilation of the colon; Megarectum; Inflammatory bowel disease - toxic megacolon; Crohn disease - toxic megacolon; Ulcerative colitis - toxic megacolon

 

Toxic megacolon occurs when swelling and inflammation spread into the deeper layers of your colon. As a result, the colon stops working and widens. In severe cases, the colon may rupture.

Causes

 

The term "toxic" means that this problem is very dangerous. Toxic megacolon may occur in people with an inflamed colon due to:

  • Ulcerative colitis, or Crohn disease that is not well controlled
  • Infections of the colon

Other forms of megacolon include pseudo-obstruction, acute colonic ileus, or congenital colonic dilation. These conditions do not involve an infected or inflamed colon.

 

Symptoms

 

The rapid widening of the colon may cause the following symptoms to occur over a short period of time:

  • Painful and distended abdomen
  • Fever

If the colon ruptures, symptoms may include

  • Rapid heart rate
  • Shock, when a bodywide infection leads to dangerously low blood pressure

 

Exams and Tests

 

A physical exam may reveal signs of septic shock. The health care provider will notice tenderness in the abdomen and possible loss of bowel sounds.

Tests:

  • Abdominal x-ray, ultrasound, CT scan, or MRI scan 
  • Blood electrolytes
  • Complete blood count

 

Treatment

 

Treatment of the disorder that led to toxic megacolon may be started, including:

  • Steroids and other medicines that suppress the immune system
  • Antibiotics

If you have septic shock, you will be admitted to the intensive care unit of the hospital. Treatment may include:

  • Breathing machine (mechanical ventilation)
  • Dialysis for kidney failure
  • Drugs to treat low blood pressure, infection, or poor blood clotting
  • Fluids given directly into a vein (intravenously)
  • Oxygen

If rapid widening is allowed to continue, an opening or rupture can form in the colon. Therefore, most cases of toxic megacolon will need surgery to remove a part of or the entire colon.

You may receive antibiotics to prevent sepsis (a severe infection).

 

Outlook (Prognosis)

 

If the condition does not improve, it can be life threatening. In this case, a colectomy is usually needed.

 

Possible Complications

 

Complications may include:

  • Perforation of the colon
  • Sepsis
  • Shock

 

When to Contact a Medical Professional

 

Go to the emergency room or call the local emergency number (such as 911) if you develop severe abdominal pain, especially if you also have:

  • Bloody diarrhea
  • Fever
  • Frequent diarrhea
  • Rapid heart rate
  • Tenderness when the abdomen is pressed

 

Prevention

 

Treating diseases that cause toxic megacolon, such as ulcerative colitis or Crohn disease, can prevent this condition.

 

 

References

Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141.

Marrero F. Severe complications of inflammatory bowel disease. Med Clin North Am. 2008;92:671-686. PMID: 18387381 www.ncbi.nlm.nih.gov/pubmed/18387381.

Peterson MA. Disorders of the large intestine. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 95.

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    • Toxic megacolon

      Toxic megacolon

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    • Crohn's disease - affected areas

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          Review Date: 10/27/2015

          Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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