Toxic Megacolon

Toxic megacolon is a feared complication of many intestinal diseases. It is essentially a distention (and enlargement) of the large intestine with disruption of its motility.


Toxic megacolon is a possible complication of severe ulcerative colitis and less commonly of the Crohn's disease. Furthermore, it may also occur in serious forms of pseudomembranous colitis (and other infectious inflammations of the large intestine) and ischemic colitis. Toxic megacolon is typical for certain congenital bowel disorders such as the Hirschsprung's disease.


A part of the large intestine gets distended due to disruption of peristalsis and accumulation of stool. The patient suffers from abdominal pain, inflation of the abdomen and nausea. The main problems are bacteria and their toxic products. They accumulate in the intestine and pass through the intestinal wall into the abdominal cavity. This gives rise to peritonitis, septicemia and fatal septic shock condition (rapid pulse, low blood pressure, pallor and fever).


Physical examination shows symptoms of acute abdomen (inaudible bowel sounds, tactile abdominal pain, etc.). Blood tests confirm the presence of inflammation with elevated white blood count, sedimentation rate and CRP. The abdominal X-ray, ultrasound and computed tomography visualize the distended large colon.


The toxic megacolon must be regarded as a life-threatening condition. The patient should be hospitalized in the ICU with continuous monitoring one’s vital signs. Fluid and food intake by mouth must be avoided and the patient must be hydrated intravenously. The infection must be aggressively treated with antibiotics and prokinetic agents can be administered to support the peristalsis. If there is no renewal of the gut motility within 48 to 72 hours, the surgery must be performed with the removal of the affected part of the large intestine. Mostly it is necessary to create a temporary ileostomy (outlet of the small intestine to the surface of the body) or colostomy (colon opening leading out to the surface of the body).


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources