Toxic megacolon

Abstract

Toxic Megacolon (TM) is a rare life-threatening clinical entity characterized by total or segmental colonic distension in the setting of acute colitis and signs of systemic toxicity. It arises in a setting of almost any colitis, however ulcerative colitis (UC) and clostridium difficile-associated disease (CDAD) are the most common causes. The mainstays of diagnosis are clinical and laboratory assessment of systemic toxicity and underlying colitis as well as abdominal imaging demonstrating colonic distension. Medical therapy including resuscitation, electrolyte repletion, antibiotics, discontinuation of antimotility agents, and treatment of the underlying colitis is warranted in the absence of severe toxicity, perforation, or severe hemorrhage. However, 25–50% of patients with TM ultimately require colectomy, typically in the form of total abdominal colectomy with end ileostomy.