Toxic colitis and toxic megacolon

Last reviewed: 21 Apr 2022
Last updated: 18 Nov 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fevers/chills
  • tachycardia
  • mental status changes
  • hypotension
  • abdominal distention
More key diagnostic factors

Other diagnostic factors

  • diarrhoea
  • abdominal pain
  • abdominal tenderness
Other diagnostic factors

Risk factors

  • ulcerative colitis (UC)
  • Crohn's colitis
  • pseudomembranous colitis
  • infectious colitis
  • HIV/AIDS/immunosuppression
  • discontinuation of medications for inflammatory bowel disease
  • antimotility agents
  • chemotherapy/chemical immunosuppression
  • electrolyte abnormalities
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC
  • serum electrolytes
  • serum albumin levels
  • serum lactic acid
  • stool studies
  • CT abdomen/pelvis
  • abdominal x-ray
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • C-reactive protein (CRP)
  • erythrocyte sedimentation rate (ESR)
  • blood cultures
  • sigmoidoscopy
  • rectal biopsy
  • surgical specimen
More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Jan Rakinic, MD

Chief

Colorectal Surgery

Department of Surgery

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JR is the President of the American Board of Colon and Rectal Surgery.

V. Prasad Poola, MD, MBBS, MS, FASCRS

Assistant Professor of Surgery

Department of Surgery

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

VPP declares that he has no competing interests.

Acknowledgements

Dr Jan Rakinic and Dr V. Prasad Poola would like to gratefully acknowledge Dr Scott A. Strong, Dr Mukta V. Krane, and Dr Alessandro Fichera, previous contributors to this topic.

Disclosures

SAS, MVK, and AF declare that they have no competing interests.

Peer reviewers

Sharon Stein, MD

Assistant Professor of Surgery

Division of Colon and Rectal Surgery

University Hospital Case Medical Center

Cleveland

OH

Disclosures

SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

James Wheeler, MB, BCh, MD, FRCS

Consultant

Colorectal Surgeon

Addenbrookes Hospital

Cambridge

UK

Disclosures

JW declares that he has no competing interests.

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