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Toxic megacolon

It is a medical emergency as it carries a high risk of perforation. It is characterised by non-obstructive colonic dilatation of more than 6cm with signs of systemic toxicity. The dilatation can be either total or segmental. TMC is most commonly associated with inflammatory bowel disease (IBD), especially ulcerative colitis (UC), however any condition that leads to inflammation of the colon can cause TMC. TMC can complicate acute bacterial dysentery, C difficile infection, or ischaemic colitis. In the immunocompromised patient, in particular those who are the HIV positive, cytomegalovirus is the leading cause. C difficile is the commonest bacterial cause. TMC in the setting of Crohn’s disease…

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 EM@3AM: Toxic Megacolon

Defined as nonobstructive colonic dilation > 6 cm with systemic toxicity... The most concerning complication of toxic megacolon is perforation, which may occur even without dilation.

Articles of Interest

Toxic megacolon: A tricky diagnosis

Bottom line: the triad of bloody diarrhea, belly pain and distention in someone with a colitis history of any kind, especially if they’ve had a recent colonoscopy, should spark a consideration for Toxic megacolon, as mortality is up to 80% if not treated quickly.

AM Report 12/6/2016: Toxic Megacolon

Initial therapy is medical, which is successful in preventing surgery in up to 50% of patients.

Diagnostic Ageism: When Not to Miss Toxic Megacolon

Clostridium difficile infection (CDI) causes a spectrum of symptoms from diffuse, watery diarrhea to fulminant disease with toxic megacolon, shock and even death. Adult physicians are more familiar with signs and symptoms due to higher burden of infection in elderly. However, cases of CDI are on the rise in children.

Resources

Toxic Megacolon

So, I figured I'd give this blogging thing a try. It's not that I think I am that interesting or anything. For anyone curious about the origin of the name, I am a medical student and always thought toxic megacolon was one of the coolest complications of a disease. I also thought it would be a great name for a hard core rock band, but since I am not that musically inclined, I figure the best way to stake my claim to it would be to create a blog.

Radiopaedia

Toxic megacolon is an acute complication that can be seen in both types of inflammatory bowel disease, and less commonly in infectious colitis and other types of colitis. It is due to fulminant colitis which causes loss of neurogenic tone of the colon leading to severe dilatation and increasing the risk of perforation.

What's the Diagnosis? Critical Care Edition

Actual incidence is unknown, but it is believed that TM is rising because of increasing cases of Clostridium difficile and the aging population.

Life in the Fastlane

CAUSES: Clostridium difficile pseudomembranous colitis, Other infections – Salmonella, Shigella, Entamoeba, Inflammatory bowel disease — Ulcerative colitis, Crohn’s disease, Ischaemic colitis.

StatPearls

Toxic megacolon is a rare but potentially deadly complication of colonic inflammation. Its definition is a nonobstructive dilation of the colon, which can be total or segmental and is usually associated with systemic toxicity. It is most commonly associated with inflammatory bowel disease, especially ulcerative colitis, yet any condition that leads to inflammation of the colon can potentially cause toxic megacolon.

WikEM

Colonic Dilation ≥6cm.