Toxic megacolon is characterized by severe inflammation that causes the colon to become dilated or stretched. “This can lead to systemic toxicity, which causes low blood pressure, fevers, and a high heart rate,” says Amanda M. Johnson, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota. 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 Clostridium difficile (C. diff), says Dr. Johnson. The infection inflames the colon, which then distends and becomes toxic to the body. People with UC are also more likely to contract C. diff than people without UC, she says. 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?
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 to colon to malfunction, limiting its ability to remove gas or feces. “If that continues and the colon continues to stretch and dilate, and it’s not removing any gas or stool, that’s when there’s risk for colon rupture,” says Johnson. “The tissue can actually start to die off,” says Johnson.
What Are the Warning Signs of Toxic Megacolon?
If a person is unable to pass gas or feces, they’re going to experience symptoms such as diarrhea, which is often bloody, and significant abdominal pain, she says. “As the name suggests, once a person develops toxic megacolon … the heart rate becomes more rapid, they may have fevers, and their blood pressure is a little lower,” says Johnson.
How Is Toxic Megacolon Diagnosed?
Diagnosis of toxic megacolon is based on multiple factors, says Johnson. These include:
Physical symptoms, such as belly pain or swelling and diarrheaSigns of toxicity, including fever, elevated heart rate, and lower blood pressureA blood test that can indicate elevated white blood cellsAn X-ray or a CT scan of the belly to show if the colon is dilated.
What Is the Treatment for Toxic Megacolon?
Targeting the underlying disease — whether that’s Crohn’s or UC — will help treat toxic megacolon, says Johnson. “We will often use steroids in ulcerative colitis to try to calm down the inflammation, she says. “It’s also important to make sure that the person does not have C. diff,” she 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,” says Johnson. She adds that people should also try to stop using opioids and antidiarrheal medications when possible.
What Can Happen if Toxic Megacolon Goes 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’s caused by your body releasing chemicals into the bloodstream to fight off an infection, says Pishvaian. Sepsis can cause organ failure, a drop in blood pressure, and more. If you develop toxic megacolon, you’ll likely need surgery, says Johnson. “If there’s no response to medical therapy within the first few days, if there’s any 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 the toxic megacolon, it’s likely that the person will have their colon removed,” says Johnson.
Signs You Need to See a Healthcare Provider Right Away
If you have UC, you’re probably used to dealing with diarrhea or abdominal pain. But if you develop toxic megacolon, those symptoms will feel much more intense. “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. Having a fever or bloating in the abdomen would also be potential warning signs of toxic megacolon; if that’s happening, seek medical care immediately, she says.
