What You Need to Know About Toxic Megacolon

Learn how to identify the signs of this painful colon condition and what you can do to lower your risk.

If you have inflammatory bowel disease, or any other forms of colitis such as infectious, ischaemic or radiation colitis, then you are at risk for developing an abnormal dilation of your large intestine (your colon), known as toxic megacolon. It is a rare but serious condition, with potentially severe complications. Find out the symptoms to look out for, how toxic megacolon can be treated, and how to prevent getting it in the first place.

What is toxic megacolon?

Toxic megacolon is the medical term for an acute toxic inflammation of the large intestine (colitis) with pathological enlargement of the colon. When this happens, the colon is unable to remove gas or feces from the body. If gas and feces build up in the colon, your large intestine may eventually rupture. Toxic megacolon can be deadly because it puts you at risk for rupture of your colon. As such, toxic megacolon is a life-threatening condition that needs immediate treatment.

What are the symptoms of toxic megacolon?

Toxic megacolon usually occurs as a consequence of colitis, or inflammation of the colon. This colitis is most often in the setting of inflammatory bowel diseases like ulcerative colitis or Crohn’s disease. When toxic megacolon occurs, the large intestines rapidly expand. The rapid widening of the colon may cause the following symptoms to occur over a short period of time:

  • Painful and distended abdomen
  • Vomiting
  • Fever
  • Bloody diarrhea, or rectal bleeding
  • Rapid heart rate

If the colon ruptures, the patient may then develop an infection throughout the body, shock, and dehydration.

Seek immediate medical help or have someone call 911 if you have severe stomach pain and the above-mentioned symptoms.

What are the risk factors and causes of toxic megacolon?

The root cause of toxic megacolon is inflammation of the bowel, which causes swelling and irritation in parts of your digestive tract, which leads to permanent damage to your large and small intestines. Risk factors for toxic megacolon include:

  • Ulcerative colitis
  • Crohn’s disease
  • Infections of the colon. These can be caused by C difficile or other infectious causes of colitis.
  • Ischemia, or low blood flow to the colon
  • In rare situations, colon cancer

In addition to the above risk factors, people with a history of any of the following can also present with toxic megacolon: recent travel, antibiotic use, chemotherapy, diabetes, organ transplants, kidney failure, suppressed immunity.

How is toxic megacolon diagnosed?

If your doctor suspects toxic megacolon from the description of your symptoms, and from their examination findings on you, they may go on to order some other tests to confirm their diagnosis, including:

  • Abdominal X-rays
  • CT scan of the abdomen
  • Blood tests

What are the complications of toxic megacolon?

The dreaded complication of toxic megacolon is rupture of your colon. Rupture of the colon is a life-threatening condition. If your intestines rupture, bacteria that are normally present in your intestine release into your abdomen, which can cause a serious infection, septic shock, and even death. Other complications of toxic megacolon include:

  • Bleeding and blood loss
  • Whole-body infection (sepsis)
  • Abnormal hole in the colon (perforation)
  • Shock

How can I prevent toxic megacolon?

Toxic megacolon is a complication of inflammatory bowel diseases. Therefore, if you have any of the inflammatory bowel conditions, it is very important to follow your doctor’s advice on taking medication and making healthy lifestyle changes. Following your doctor’s advice will help control the symptoms of IBD, and reduce the development of permanent damage that leads to toxic megacolon.

How is toxic megacolon treated?

Treatment of toxic megacolon includes:

  • Medicines. Treating the original condition or infection may help reduce toxic megacolon. Anti-inflammatory medicines help to reduce inflammation. Antibiotics help to treat or prevent infection.
  • Bowel rest and decompression. These treatments remove gas and substances filling the colon to prevent pressure build-up, and eventual rupture.
  • IV fluids. You may be given an IV of fluids and electrolytes to help nourish your body and prevent dehydration.
  • Surgery. If less invasive treatments don’t reduce the size of the toxic megacolon within 2 to 3 days, you may need surgery to remove part or all of the colon.

If you develop septic shock as part of the spectrum of disease of toxic megacolon, you will be admitted to the intensive care unit of the hospital. Treatment there may include:

  • Mechanical ventilation on a breathing machine
  • Dialysis for kidney failure
  • Drugs to treat low blood pressure, infection, or poor blood clotting
  • IV resuscitation
  • Oxygen

What is the outlook for toxic megacolon?

If the condition does not improve with medication and bowel rest, it can be life-threatening, in which case a colectomy is usually needed. Unfortunately, with continued bowel inflammation, there is a persistent risk of developing toxic megacolon again.


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