The daily educational pearl – Toxic megacolon

Toxic megacolon

= colonic dilation (>6cm) with systemic toxicity, usually due to a acute colitis of different causes. It can involved the whole colon or only one segment.


Clostridium difficile pseudomembranous colitis

Other infections – Salmonella, Shigella, Entamoeba

Ulcerative colitis

Crohn’s disease

Ischaemic colitis

The patient usually presents with abdominal pain / abdominal distension, fever, bloody diarrhoea and often have signs of shock. On the abdominal Xray or CT scan there are signs of colonic dilation (diameter > 6cm, loss of haustra).

It can be complicated by perforation and / or sepsis / septic shock.

Mortality is very high, especially for cases that do not respond to conservative management.

Treatment is initially conservative, but if there is no response in 24 – 72 hours they normally proceed to surgical intervention/ colectomy.

Conservative management includes:

– aggressive fluid resuscitation +/- vasopressor support

– iv antibiotics (broad spectrum)

– keep the patient nil by mouth and NG tube for bowel decompression

– avoid medications that reducing GI motility (opiates)