What is Toxic Megacolon?

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  • Written By: Mary McMahon
  • Edited By: Kristen Osborne
  • Last Modified Date: 10 October 2019
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Toxic megacolon is a rare complication of irritable bowel disease where the colon becomes distended and is at risk of rupture. Treatment begins with medical attempts to address the distention and if these are not sufficient, the patient may need to have surgery to remove the colon. Managing irritable bowel disease, especially during flareups, should reduce the risks of developing toxic megacolon. Patients with known gastrointestinal problems need to contact their physicians if they experience symptoms like bloody diarrhea, abdominal pain and tenderness, and bloating.

In toxic megacolon, inflammatory processes cause the colon to start to distend, and the distention can be made more severe by swallowed air. The patient may have a feeling of fullness in the abdomen in addition to developing bloating and discomfort. Diarrhea can develop, as can a rapid heart rate, and the patient can become dehydrated. Failing to treat the condition can result in rupture of the walls of the colon, leading to severe infection, shock, and possibly death.


Medical imaging studies can be used to look at the colon. Endoscopy is usually not recommended because of the associated risks of rupture. The patient will be provided with fluids in the short term to address dehydration and shock, and medical management of the toxic megacolon will be attempted to see if the swelling can be brought down. If the patient does not respond within 24 hours of treatment or the condition gets much worse, the patient will be advised to go to surgery for removal of the colon.

In the surgery, the distended segment of the colon will be removed. The patient may be fitted with a colostomy, allowing feces to drain into a bag outside the body through a hole in the abdomen, or the surgeon may attempt an anastomosis, where the severed end of the intestine is reconnected with the anal canal to allow the patient to defecate. The option chosen by the surgeon varies depending on what is found inside the abdomen during the surgery.

Patients with severe irritable bowel disease are more likely to develop this complication, as are patients who do not manage their conditions effectively. Failure to adhere to treatment regimens can increase inflammation, exposing patients to increased risks. A patient who is having trouble with a treatment plan should discuss options with a physician to develop a more effective plan the patient can stick to in order to reduce the risk of complications like toxic megacolon.


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