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Toxic colitis and toxic megacolon

Last reviewed: 12 Nov 2024
Last updated: 29 Jul 2022

Summary

Definition

History and exam

Key diagnostic factors

  • history of inflammatory bowel disease
  • history of exposure to infectious agents
  • history of recent antibiotic use
  • history of HIV/AIDS/immunosuppressed state
  • fevers/chills
  • tachycardia
  • mental status changes
  • hypotension
  • abdominal distention
Full details

Other diagnostic factors

  • diarrhea
  • abdominal pain
  • abdominal tenderness
Full details

Risk factors

  • ulcerative colitis (UC)
  • Crohn colitis
  • pseudomembranous colitis
  • infectious colitis
  • HIV/AIDS/immunosuppression
  • discontinuation of medications for inflammatory bowel disease
  • antimotility agents
  • chemotherapy/chemical immunosuppression
  • electrolyte abnormalities
Full details

Diagnostic tests

1st tests to order

  • CBC
  • serum electrolytes
  • serum albumin levels
  • serum lactic acid
  • stool studies
  • CT abdomen/pelvis
  • abdominal x-ray
  • chest x-ray
Full details

Tests to consider

  • CRP
  • erythrocyte sedimentation rate (ESR)
  • blood cultures
  • sigmoidoscopy
  • rectal biopsy
  • surgical specimen
Full details

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, MBBS, FACS, FASCRS

Associate 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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