Toxic megacolon

Causes

Toxic megacolon occurs as a complication of inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease, and infections of the colon. The term "toxic" means that this complication occurs with infection or inflammation and is very dangerous.

This is not the same as other forms of megacolon, such as pseudo-obstruction, acute colonic ileus, or congenital colonic dilation. These conditions occur without infection or inflammation.

Symptoms

The rapid widening of the colon may cause the following symptoms:

• Abdominal pain
• Abdominal distention
• Abdominal tenderness
• Fever
• Rapid heart rate
• Shock

Exams and Tests

The rapid widening (dilation) of the colon makes this different from other conditions, such as chronic constipation, that can widen the colon slowly and do not cause sudden, life-threatening symptoms.

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

Tests:

• Abdominal x-ray
• Blood electrolytes
• Complete blood count

Treatment

You will get fluids and electrolytes to help prevent dehydration and shock. The process that leads to megacolon can be treated. However, this is usually not enough to reverse the megacolon.

If rapid widening is allowed to continue, an opening (perforation) can form in the colon. Therefore, most cases of toxic megacolon will need surgery, such as colectomy (removal of 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

• 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's disease, can prevent this condition.

Alternative Names

Toxic dilation of the colon; Megarectum

References

Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 143.

Peterson MA. Disorders of the large intestine. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 93.

Marrero F. Severe complications of inflammatory bowel disease. Med Clin North Am. 2008;92:671-686.

Update Date: 1/27/2012

Updated by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.