Toxic colitis and toxic megacolon - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Toxic colitis with dilated colon is referred to as toxic megacolon; dilation may be segmental or generalized. Toxic colitis can develop without megacolon.
An acute presentation from inflammatory or infectious colitis with significant morbidity and mortality.
Symptoms and signs of systemic toxicity are always present.
Criteria for the diagnosis include radiographic evidence of acute colitis and three of the following four features: fever >101.5°F (38.6°C), heart rate >120 bpm, white blood cell count >10.5 x 10⁹/L, or anemia. One of the following is also required: volume depletion, mental status changes, electrolyte abnormalities, or hypotension.
Operative treatment is indicated by the presence of complications (perforation, massive rectal bleeding) or lack of clinical improvement after appropriate medical therapy for approximately 72 hours.

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Abdominal x-ray demonstrating colonic dilation
Histologic appearance of toxic megacolon
Gross pathology of toxic megacolon

Citations

Key Articles

Rubin DT, Ananthakrishnan AN, Siegel CA, et al. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019 Mar;114(3):384-413.[Abstract][Full Text]
McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19;66(7):987-94.[Abstract][Full Text]
Kelly CR, Fischer M, Allegretti JR, et al. ACG clinical guidelines: prevention, diagnosis, and treatment of Clostridioides difficile infections. Am J Gastroenterol. 2021 Jun 1;116(6):1124-47.[Abstract][Full Text]
Lightner AL, Vogel JD, Carmichael JC, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the surgical management of Crohn's disease. Dis Colon Rectum. 2020 Aug;63(8):1028-52.[Abstract][Full Text]

Referenced Articles

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