- Toxic megacolon is colonic dilation (>6cm) with systemic toxicity, usually due to an acute colitis.
- can involve the whole colon or only one segment.
- Clostridium difficile pseudomembranous colitis
- Other infections – Salmonella, Shigella, Entamoeba
- Inflammatory bowel disease — Ulcerative colitis, Crohn’s disease
- Ischaemic colitis
- abdominal pain
- abdominal distension
- bloody diarrhoea
- septic shock
- abdominal Xray or CT scan — colonic dilation (diameter > 6cm, loss of haustra).
- aggressive fluid resuscitation +/- vasopressor support
- IV antibiotics (broad spectrum, e.g tazocin)
- NBM and NG tube for bowel decompression
- avoid medications that reducing GI motility (opiates)
if there is no response in 24 – 72 hours usually proceed to surgical intervention/ colectomy.
- Mortality is high, especially if no response conservative management.