- Sunil G Sheth, MD
Sunil G Sheth, MD
- Assistant Professor of Medicine
- Harvard Medical School
- J Thomas Lamont, MD
J Thomas Lamont, MD
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — Anorectal Disorders and Misc. Lower GI Disease
- Section Editor — Nutrition, Malabsorption, and Misc. Upper GI Disease
- Professor of Medicine
- Harvard Medical School
- Section Editors
- Martin Weiser, MD
Martin Weiser, MD
- Section Editor — Colorectal Surgery
- Professor of Surgery
- Weill Cornell Medical College
- Memorial Sloan Kettering Cancer Center
- Paul Rutgeerts, MD, PhD, FRCP
Paul Rutgeerts, MD, PhD, FRCP
- Section Editor — Inflammatory Bowel Disease
- Emeritus Professor of Medicine
- University Hospital, Leuven, Belgium
Toxic megacolon is a potentially lethal complication of inflammatory bowel disease (IBD) or infectious colitis that is characterized by total or segmental nonobstructive colonic dilatation plus systemic toxicity [1-3]. Colonic dilatation is also observed in patients with congenital megacolon (Hirschsprung's disease), idiopathic or acquired megacolon occurring with chronic constipation of any etiology, and intestinal pseudoobstruction, a manifestation of diffuse gastrointestinal dysmotility of various causes. However, the lack of systemic toxicity distinguishes these presentations from true toxic megacolon. (See "Acute colonic pseudo-obstruction (Ogilvie's syndrome)".)
The precise incidence of toxic megacolon is unknown. The incidence in ulcerative colitis and Crohn's disease was approximately 1 to 5 percent three decades ago , but has gradually decreased because of earlier recognition and intensive management of severe colitis. Clinically symptomatic Clostridium difficile infection occurs in approximately 1 percent of all hospitalized patients; a few of these may develop severe colitis with toxic megacolon [5-7]. (See "Clostridium difficile infection in adults: Clinical manifestations and diagnosis".)
Although most commonly recognized as a complication of inflammatory bowel disease (IBD), toxic megacolon may also occur with infectious colitides of diverse etiology, ischemic colitis, volvulus, diverticulitis, and obstructive colon cancer (table 1).
●Clinical features that suggest IBD as a cause of toxic megacolon include a preceding history of diarrhea, bloody stools, abdominal pain, perianal disease, or extraintestinal manifestations such as arthritis, iritis, skin disease, or liver disease. (See "Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults" and "Clinical manifestations, diagnosis and prognosis of Crohn disease in adults".)
●Risk factors for the development of severe colitis in patients with C. difficile infection include malignancy, chronic obstructive pulmonary disease, immunosuppressive therapy, renal failure, or exposure to antiperistaltic medications or clindamycin . Toxic megacolon has been described in patients with recurrent C. difficile .
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- Nitric oxide
- CLINICAL MANIFESTATIONS
- Laboratory studies
- Therapy of toxic megacolon in patients with IBD
- Medical therapy in patients with other disorders
- SUMMARY AND RECOMMENDATIONS