Toxic Megacolon: Symptoms, Causes, Diagnosis, Treatment, and Prevention

As its name suggests, toxic megacolon is a serious complication that can occur in people who have inflammatory bowel disease (IBD). The condition is more common in people with ulcerative colitis (UC) than those with Crohn’s disease. Toxic megacolon is characterized by severe inflammation that causes the colon to become dilated or stretched. The muscles in your colon may stop working, allowing food and gas to build up in the colon and toxins to leak into your bloodstream, according to the Cleveland Clinic . Eventually, this leads to systemic toxicity, says Amanda M. Johnson, MD , a gastroenterologist at the Mayo Clinic in Rochester, Minnesota. “Systemic toxicity causes low blood pressure, fevers, and a high heart rate,” says Dr. Johnson. “Because of its life-threatening nature, toxic megacolon requires immediate medical attention and treatment.”
Who Is at Risk of Developing Toxic Megacolon? Toxic megacolon can be a complication of a few different diseases, says Aline Charabaty Pishvaian, MD , the director of the inflammatory bowel disease center at Sibley Memorial Hospital in Washington, DC. This includes ulcerative colitis , Crohn’s disease, and certain infections. The most common infection that can lead to toxic megacolon is caused by a bacterium called Clostridioides difficile ( C. diff ), says Johnson. The infection inflames the colon, which then distends and becomes toxic to the body. People with UC are more likely to contract C. diff than people without UC, she says. A review published in August 2020 in Intestinal Research found that rates of C. diff were tripled in people with UC and doubled for those with Crohn’s disease.
People with uncontrolled UC or who are experiencing flares can have very intense inflammation within the wall of the colon, which puts them at higher risk for toxic megacolon, says Johnson. For this reason, the risk of toxic megacolon can be even greater in the early stages of a person’s disease. People who are having flares and using opioids , narcotics, or antidiarrheal medications to control their symptoms can also be at greater risk for toxic megacolon, says Johnson. “If a person with colitis is having a flare or is hospitalized, we try to avoid using opiates and antidiarrheal medications, if at all possible, for that reason,” she adds. What Causes Toxic Megacolon? Toxic megacolon is a rare complication that affects about 5 percent of people with severe UC, according to the Clinics in Colon and Rectal Surgery . When someone with UC is having an active flare, they develop intense inflammation within the wall of their colon. “That ultimately leads to the dilation or the stretching out of the colon,” says Johnson. “As it becomes thinner and the inflammation extends deeper through the wall of the colon, it seems to almost paralyze the muscles of the colon.” This causes the colon to malfunction, limiting its ability to remove gas or feces. What Are the Warning Signs of Toxic Megacolon? Toxic megacolon has a number of symptoms that are similar to other problems. But if someone has an IBD and a combination of the following symptoms outlined by Cleveland Clinic, it may be worth seeing a doctor. Swelling or pain in the stomach Fever Rapid heart rate Diarrhea Shock Low blood pressure How Is Toxic Megacolon Diagnosed? If you are experiencing symptoms and think it may be toxic megacolon, it’s important to seek medical help right away. “A person should call their doctor or go to the emergency room if their abdominal pain becomes much more acutely severe or if the amount of bloody diarrhea is increasing,” says Johnson. A fever or bloating in the abdomen are also potential warning signs of toxic megacolon; if that’s happening, seek medical care immediately, she says. In addition to recording a list of your symptoms, Johnson says your doctor might also request tests like a blood test that can indicate elevated white blood cells or an X-ray or a CT scan of the belly to show if the colon is dilated. What Is the Treatment for Toxic Megacolon? Treatment for toxic megacolon includes anti-inflammatory medicine to control the inflammation and antibiotics to prevent infection. Other medicines, like opioids and nonsteroidal anti-inflammatory medicines, may be stopped because of possible complications. But if someone has UC, the underlying disease also needs to be addressed. Steroids are often used in ulcerative colitis to try to calm down the inflammation, Johnson says. “If a person has an ulcerative colitis flare, and they also have an infection with the colon, specifically with C. diff , we need to treat the ulcerative colitis with steroids and the C. diff infection with very specific antibiotics.” Other noninvasive treatments include bowel rest to remove built-up gas and IV fluids to replace lost electrolytes. Extreme cases may require surgery to remove part or all of the colon, according to Johns Hopkins Medicine . “If there’s no response to medical therapy within the first few days or concern about the viability or the blood flow to the colon, or if the person is having worsening abdominal pain or any other complications due to toxic megacolon, it’s likely that they will need to have their colon removed,” says Johnson. What Can Happen if Toxic Megacolon Goes Untreated? If toxic megacolon is left untreated the colon can perforate, meaning a hole can form in the colon, allowing stool to spill into the abdominal cavity, says Dr. Pishvaian. “That’s a very dangerous situation that can greatly increase the risk of death or long-term complications,” she says. “It would require emergency surgery.” There is also a risk of developing sepsis, a life-threatening condition that occurs when your body releases chemicals into the bloodstream to fight off an infection, says Pishvaian. Sepsis can cause organ failure, a drop in blood pressure, and more, according to the Centers for Disease Control and Prevention (CDC) . How to Prevent Toxic Megacolon Monitoring and staying vigilant about your IBD is the best way to prevent toxic megacolon, according to Mount Sinai . Good treatment for diseases like UC that can cause toxic megacolon, no matter how rare the chance is, can prevent this condition.



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