eMedicine Specialties > Gastroenterology > Colon

Megacolon, Toxic: Follow-up

Author: Deepika Devuni, MBBS, Resident Physician, Department of Internal Medicine, University Of Connecticut
Coauthor(s): Lisa M Rossi, MD, Fellow, Department of Gastroenterology-Hepatology, University of Connecticut School of Medicine; George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine; Jerome H Liu, MD, Staff Physician, Department of Surgery, University of California at Los Angeles Medical Center; Clifford Y Ko, MD, MS, Assistant Professor, Department of Surgery, University of California at Los Angeles School of Medicine
Contributor Information and Disclosures

Updated: Apr 14, 2009

Follow-up

Complications

  • The complication of toxic megacolon (toxic colitis) one must constantly be alert for is perforation, even in the absence of colonic dilatation.
  • Numerous studies have demonstrated that classic physical signs of peritonitis are absent in the majority of patients with free perforation, possibly because of the effects of steroids.

Prognosis

  • A few studies have shown that the prognosis is poor with medical management of toxic megacolon (toxic colitis). A study by Grant and Dozois followed the clinical course and ultimate outcome in 38 patients with toxic megacolon (toxic colitis) who were successfully treated nonoperatively.22  Thirty-two patients had ulcerative colitis and 6 had Crohn disease, with complete follow-up, ranging 3-22 years (average 13 y). Eleven of 38 patients (29%) eventually suffered a second episode of fulminant acute colitis or recurrent toxic megacolon (toxic colitis). Ultimately, a total of 18 patients (47%) underwent colon resection, which was performed on an emergency or urgent basis in 15 patients.22
  • The survival prognosis of toxic megacolon (toxic colitis) should be excellent in the absence of perforation. If perforation occurs, the mortality is approximately 20%.
  • In the case of ulcerative colitis, a proctocolectomy cures patients of the disease.
  • In the case of Crohn disease, proctocolectomy does not necessarily cure the patient, because Crohn disease can occur in any portion of the gastrointestinal tract.
  • With use of TNF-alpha inhibitors, hopefully more cases can be managed medically in future. More studies are needed.

Patient Education

  • Educating the patient about toxic megacolon (toxic colitis) is crucial.
  • First, educate the patient about toxic megacolon (toxic colitis) and the causes of the disease.
    • The most common cause of toxic megacolon (toxic colitis) is inflammatory bowel disease. However, with the rising incidence of C difficile, pseudomembranous colitis must always be considered, even in patients with inflammatory bowel disease.
    • Educate the patient about ulcerative colitis, Crohn disease, and indeterminate colitis.
    • The patient should be clearly informed that, if an operation is required for this acute problem, an ostomy likely will be the procedure needed, regardless of the cause.
  • Secondly, educate the patient about the operation.
    • Patients require at least a temporary, and possibly a permanent, ostomy.
    • Most patients require a thoughtful, compassionate discussion regarding this aspect. The psychologic aspects of dealing with an ostomy can be extremely difficult.
  • Finally, educate patients so they understand that this disease is a process that may require several months to overcome if an operation is needed and that a 2-stage or 3-stage procedure is usually required.

Miscellaneous

Medicolegal Pitfalls

  • Communicating with the patient and patient's family at all times is imperative. Toxic megacolon (toxic colitis) can be fatal, and clear lines of communication are essential.
  • Because the surgical treatment for toxic megacolon (toxic colitis) requires an ostomy, the patient must give clear, informed consent. In addition, discussing the implications of an ostomy with the patient and the patient's family is helpful. Also, it is important to tell the patient that surgical treatment may be staged such that reoperation is required in the future.
 


More on Megacolon, Toxic

Overview: Megacolon, Toxic
Differential Diagnoses & Workup: Megacolon, Toxic
Treatment & Medication: Megacolon, Toxic
Follow-up: Megacolon, Toxic
Multimedia: Megacolon, Toxic
References
Further Reading
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References

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  2. Jalan KN, Sircus W, Card WI, et al. An experience of ulcerative colitis. I. Toxic dilation in 55 cases. Gastroenterology. Jul 1969;57(1):68-82. [Medline].

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Further Reading

Related eMedicine Topics

Best Evidence

Clinical Trials

National Guidelines Clearinghouse

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Keywords

toxic megacolon, megacolon, dilated toxic colitis, fulminant dilated colitis, colonic dilatation, colitides, Hirschsprung disease, ulcerative colitis, Crohn disease, amebic dysentery, clostridium enterocolitis, idiopathic megacolon, chronic constipation, intestinal pseudoobstruction, intestinal pseudo-obstruction, Ogilvie syndrome, acute toxic colitis

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Contributor Information and Disclosures

Author

Deepika Devuni, MBBS, Resident Physician, Department of Internal Medicine, University Of Connecticut
Disclosure: Nothing to disclose.

Coauthor(s)

Lisa M Rossi, MD, Fellow, Department of Gastroenterology-Hepatology, University of Connecticut School of Medicine
Disclosure: Nothing to disclose.

George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
George Y Wu, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Clinical Investigation, and Association of American Physicians
Disclosure: Humana Press Consulting fee Consulting; Novartis Consulting fee Review panel membership

Jerome H Liu, MD, Staff Physician, Department of Surgery, University of California at Los Angeles Medical Center
Disclosure: Nothing to disclose.

Clifford Y Ko, MD, MS, Assistant Professor, Department of Surgery, University of California at Los Angeles School of Medicine
Clifford Y Ko, MD, MS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, California Medical Association, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Medical Editor

Terence David Lewis, MBBS, FRACP, FRCPC, FACP, Program Director, Internal Medicine Residency, & Assistant Chairman, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, Loma Linda University Medical Center
Terence David Lewis, MBBS, FRACP, FRCPC, FACP is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, California Medical Association, Royal College of Physicians and Surgeons of Canada, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Douglas M Heuman, MD, FACP, Director of Hepatology, McGuire Veterans Affairs Medical Center, Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine
Douglas M Heuman, MD, FACP is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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