Toxic megacolon classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

Toxic megacolon may be classified according to etiology into two groups including toxic megacolon associated with inflammatory bowel disease and toxic megacolon associated with Clostridium difficile pseudomembranous colitis.

Classification

• There is no established system for the classification of toxic megacolon but it may be classified according to etiology into 2 groups:

Etiology of toxic megacolon	Pathological evolution	CT scan findings	MRI findings
Toxic megacolon associated with ulcerative colitis	Rapid damage involving all layers of the colonic wall Toxins cause a breach in the protective mucosal barrier leading to exposure of muscularis propria
Toxic megacolon associated with Crohn's disease	Occurs early in the course of Crohn's disease Develops more commonly in pancolitis than in segmental disease Cytomegalovirus infection may be a trigger
Toxic megacolon associated with Clostridium difficile pseudomembranous colitis	0.3-4 percent of cases of pseudomembranous colitis may develop toxic megacolon Toxic megacolon is thought to develop secondary to inflammatory changes that penetrate into the muscularis propria leading to neural injury, altered colonic motility and colonic dilation
Toxic megacolon associated with ischemic colitis

• • 1. Toxic megacolon associated with inflammatory bowel disease
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