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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 such as Clostridioides difficile
  • Ischemic bowel disease

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:

Exams and Tests

The health care provider will perform a physical exam. Findings may include:

The exam may reveal signs of septic shock, such as:

  • Increased heart rate
  • Mental status changes
  • Rapid heart rate
  • Low blood pressure

The provider may order any of the following tests:

Treatment

Treatment of the disorder that led to toxic megacolon includes:

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

If you have septic shock, you will be admitted to the intensive care unit (ICU) 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
  • Oxygen

If rapid widening is not treated, an opening or rupture can form in the colon. If the condition doesn't improve with medical treatment, surgery will be needed to remove part or all of the colon.

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

Outlook (Prognosis)

If the condition does not improve, it can be fatal. Colon surgery is usually needed in such cases.

Possible Complications

Complications may include:

  • Perforation of the colon
  • Sepsis
  • Shock
  • Death

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
  • Abdominal distention

Prevention

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

Open References

References

Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 132.

Nishtala MV, Benlice C, Steele SR. Management of toxic megacolon. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:180-185.

Peterson MA, Wu AW. Disorders of the large intestine. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 85.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Toxic megacolon

    Toxic megacolon - illustration

    Toxic megacolon is characterized by extreme inflammation and distention of the colon. Common symptoms are pain, distention of the abdomen, fever, rapid heart rate, and dehydration. This is a life-threatening complication that requires immediate medical treatment.

    Toxic megacolon

    illustration

  • Crohn disease - affected areas

    Crohn disease - affected areas - illustration

    The inflammation of Crohn disease is nearly always found in the ileocecal region. The ileocecal region consists of the last few inches of the small intestine (the ileum), which moves digesting food to the beginning portion of the large intestine (the cecum). However, Crohn disease can occur anywhere along the digestive tract.

    Crohn disease - affected areas

    illustration

  • Ulcerative colitis

    Ulcerative colitis - illustration

    Ulcerative colitis is categorized according to location. Proctitis involves only the rectum. Proctosigmoiditis affects the rectum and sigmoid colon. Left-sided colitis encompasses the entire left side of the large intestine. Pancolitis inflames the entire colon.

    Ulcerative colitis

    illustration

  • Digestive system organs

    Digestive system organs - illustration

    The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

    Digestive system organs

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Toxic megacolon

      Toxic megacolon - illustration

      Toxic megacolon is characterized by extreme inflammation and distention of the colon. Common symptoms are pain, distention of the abdomen, fever, rapid heart rate, and dehydration. This is a life-threatening complication that requires immediate medical treatment.

      Toxic megacolon

      illustration

    • Crohn disease - affected areas

      Crohn disease - affected areas - illustration

      The inflammation of Crohn disease is nearly always found in the ileocecal region. The ileocecal region consists of the last few inches of the small intestine (the ileum), which moves digesting food to the beginning portion of the large intestine (the cecum). However, Crohn disease can occur anywhere along the digestive tract.

      Crohn disease - affected areas

      illustration

    • Ulcerative colitis

      Ulcerative colitis - illustration

      Ulcerative colitis is categorized according to location. Proctitis involves only the rectum. Proctosigmoiditis affects the rectum and sigmoid colon. Left-sided colitis encompasses the entire left side of the large intestine. Pancolitis inflames the entire colon.

      Ulcerative colitis

      illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

     

    Review Date: 10/26/2021

    Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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