Toxic megacolon (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:Jinhui Wu, M.D.; Assistant Editor-in-Chief: Meagan E. Doherty
Overview
Toxic megacolon is a life-threatening complication of other intestinal conditions that causes rapid widening (dilation) of part of the large intestine within 1 to a few days.
What are the symptoms of Toxic megacolon?
The rapid widening of the colon may cause the following symptoms:
What are the causes of Toxic megacolon?
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.
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.
Who is at highest risk?
- Chemotherapy
- Radiation therapy
- Crohn's disease
- Hirschsprung's disease
- Intestinal infection
- Laxative abuse
- Peripheral vascular disease
- Ulcerative colitis
Diagnosis
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:
When to seek urgent medical care
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
- Painful bowel movements
- Rapid heart rate
- Tenderness when the abdomen is pressed
Treatment options
Fluids and electrolytes will be given to help prevent dehydration and shock. The process that leads to megacolon can be treated medically first. 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 require surgery, such as colectomy or removal of the entire colon.
Antibiotics may be given to prevent sepsis (a severe infection).
Medications to avoid
Patients diagnosed with toxic megacolon should avoid using the following medications:
- Alosetron
- Polyethylene glycol-electrolyte solution (PEG-ES)
If you have been diagnosed with toxic megacolon, consult your physician before starting or stopping any of these medications.
Diseases with similar symptoms
- Chagas disease
- Irritable bowel syndrome
- Celiac disease
- Crohn's disease
- Ulcerative colitis
- Diabetic gastroparesis
- Diabetic diarrhea
- Giardia
- Appendicitis
- GERD[1]
Where to find medical care for Toxic megacolon
Directions to Hospitals Treating Toxic megacolon
Prevention
Treatment of the underlying disease is important to prevent toxic megacolon.
What to expect (Outlook/Prognosis)
If the condition does not improve, there is a significant risk of death. In this situation, a colectomy is usually required.
Possible Complications
- Perforation of the colon
- Sepsis
- Shock