Toxic Megacolon – Causes, Symptoms & Treatment

Toxic megacolon

Toxic megacolon is a life-threatening complication of various intestinal diseases. The large intestine expands massively and a septic-toxic inflammation occurs.

What is a toxic megacolon?

Toxic megacolon is defined as an acute dilatation of the colon with clinically apparent inflammation of the colon . Various diseases and in particular diseases of the intestine come into consideration as causes.

However, the exact pathomechanism is not yet known. Patients with toxic megacolon experience severe pain and high fever . There is a risk of perforation of the intestine, with the contents of the intestine escaping into the abdominal cavity. Heavy bleeding or even shock can also be consequences of the toxic megacolon.


The most common cause of toxic megacolon is ulcerative colitis . It is a chronic inflammatory bowel disease that progresses in phases. The spread is continuous from the anus to the mouth. Ulcers of the upper mucosal layers are typical of the disease. If the inflammation spreads to all layers of the intestinal wall, a toxic megacolon can result.

A toxic megacolon can also develop in Crohn’s disease . Crohn’s disease is also one of the chronic inflammatory bowel diseases. Here, however, the rear section of the small intestine and the large intestine are primarily affected. The inflammation spreads discontinuously, but penetrates all layers of the mucosa.

Pseudomembranous colitis can also be the cause of a toxic megacolon. This usually occurs after prolonged antibiotic therapy . The antibiotics kill not only the pathological bacteria, but also the physiological bacteria of the intestinal flora. This allows antibiotic-resistant strains to multiply. One species of this type is the bacterium Clostridium difficile . The bacteria colonize the entire colon and secrete toxins that cause a severe inflammatory response.

Rarely, toxic megacolon is caused by Chagas disease . Chagas disease is caused by the protozoan species Trypanosoma cruzi and is mainly found in South America and the southern United States. Hirschsprung’s disease can also result in a toxic megacolon. The congenital disease is accompanied by a change in the neuronal structures of the intestinal wall nervous system.

The way in which these diseases cause a pathological enlargement of the colon has not yet been clarified. It is possible that various messenger substances, the so-called inflammatory mediators, cause muscle relaxation, which leads to a widening and bulging of the intestine.

Symptoms, Ailments & Signs

The main symptom of toxic megacolon is a distended, painful abdomen. Due to the defensive tension, the stomach feels hard. The fever is very high. This is referred to as a septic temperature. The heart beats very quickly ( tachycardia ). Due to the severe inflammation, intestinal obstruction occurs . Stool and intestinal gas can no longer pass. Those affected may vomit feces.

An untreated toxic megacolon can progress to shock. Multiorgan failure is also conceivable. If the megacolon perforates, intestinal contents leak into the abdominal cavity. It comes to a life-threatening inflammation of the abdominal cavity and the peritoneum ( peritonitis ).

Diagnosis & disease progression

Diagnosis of toxic megacolon is by x-ray . For this purpose, a so-called abdominal blank recording is made. A distended colon is visible there. Haustres are usually found in the wall of the large intestine. Haustra are bulges in the colon wall that segment the colon. In toxic megacolon, the haustres have disappeared. There may be free air in the abdominal cavity.

Due to the severe inflammation, the blood count shows an increased number of leukocytes. So there is leukocytosis . The electrolyte balance is disturbed , anemia may become apparent. The blood sedimentation rate is significantly increased.


A toxic megacolon is always an emergency and must be treated quickly. If this is not done, the resulting intestinal obstruction and the accumulation of toxins in the body will eventually lead to the death of the person concerned. If left untreated, this often leads to a perforation of the damaged colon, which eventually releases toxins and other substances into the abdominal cavity.

The result is life-threatening internal sepsis. Shock and multi-organ failure are also possible consequences if the disease is not treated. Furthermore, massive blood loss (due to bloody diarrhea) can lead to a rapid drop in blood pressure.

Treatment in the conservative way can be successful, but it is also possible that there is no improvement within a few days. In such cases, surgical intervention is necessary. For those affected by toxic megacolon, this means a permanent loss of colon tissue or the entire colon and rectum.

Accordingly, the affected person is then dependent on an artificial bowel outlet for life, insofar as a large part of the colon had to be removed. Toxic megacolon itself is a serious complication of inflammatory bowel disease (eg, ulcerative colitis or Crohn’s disease). All complications in this context can still occur during treatment.

When should you go to the doctor?

Disorders of the gastrointestinal tract, digestion and irregularities when going to the toilet should be presented to a doctor. An increased body temperature, a general feeling of illness and a feeling of being unwell indicate an illness. A doctor is needed so that the cause can be clarified.

Heart palpitations, irregular heart rhythms and inner weakness are other complaints that require a doctor’s visit. If an intestinal obstruction occurs, you should see a doctor immediately. A decrease in the usual physical strength, an inner restlessness as well as fatigue and exhaustion are signs of a health disorder.

If the everyday obligations can no longer be met, there is a need for action. Irritability, trouble sleeping, or other dysfunctions need to be discussed with a doctor. Vomiting feces is characteristic of the disease. If this happens, a doctor should be consulted as soon as possible. It can become life-threatening if medical attention is not sought.

Pain in the stomach or intestines, hardening below the chest and swelling should be examined and treated. Blood loss, a sharp drop in blood pressure and pale skin should be understood as warning signals from the body. In acute situations, an ambulance must be called. Without intensive medical care, those affected are at risk of blood poisoning, massive blood loss or damage to the organs.

Treatment & Therapy

Toxic megacolon is acutely life-threatening and therefore an intensive care emergency. The treatment takes place under constant monitoring of the patient. The main goal is to quickly relieve the burden on the large intestine and to balance the impaired electrolyte and fluid balance. In addition, the resulting toxins must be eliminated.

The therapy is usually of a conservative nature. Those affected receive plenty of fluids and also broad -spectrum antibiotics . Glucocorticoids are also used. If this does not lead to improvement, leukocyte apheresis (LCAP) can be used. Apheresis is a type of blood washing . The blood is fed through a tube into a system. There, white blood cells such as lymphocytes, granulocytes, monocytes and also thrombocytes are removed from the blood.

The filtered blood is then returned to the body. This is to reduce the inflammation. In addition, ciclosporin A and monoclonal antibodies can be prescribed. If there is no improvement within 48 to 72 hours, surgical intervention is necessary. In the operation, the colon and rectum are partially or completely removed. An ileostomy is created to drain the stool.

The ileostomy is an artificial bowel outlet (anus praeter). A deep small bowel loop is passed through the abdominal wall in the area of ​​the right lower abdomen. If the large intestine has been completely resected, the ileostomy must remain in place permanently and is then used for the final drainage of the intestinal contents. Double-barreled ileostomas are created temporarily to relieve the inflamed colon. They can be removed after healing.


Toxic megacolon can only be prevented by early and effective therapy of the underlying disease. Chronic inflammatory bowel diseases are treated with cortisone preparations, immunosuppressants or TNF-alpha blockers. Surgery may have to be performed before a toxic megacolon develops.

Pseudomembranous colitis is treated with antibiotics. Another option is stool transplantation. Antiprotozoal drugs are used to treat Chagas disease. Children with Hirschsprung’s disease need to be operated on as early as possible. The affected large intestine segments are removed and the intestine is relieved by an artificial anus before a toxic megacolon develops.


In around 40 percent of all cases of illness, toxic megacolon leads to the death of the person affected. Therapy for the bereaved is the focus of aftercare. Regular psychotherapeutic treatment is indicated for first-degree relatives to cope with the grief.

In the remaining 60 percent of cases, toxic megacolon can be treated conservatively or surgically, depending on the severity and the decision of the specialist. In conservative therapy, the task of aftercare is to continue to maintain the patient’s clinically stabilized and improved condition.

For this purpose, after the clinical stay, the further course of the disease is closely monitored clinically and also radiologically. In addition, laboratory tests of the blood and stool must be carried out regularly on the person concerned. The measures are intended to prevent the surgical indication from being carried over.

After an operation on the toxic megacolon, the range of necessary follow-up examinations and treatments is very diverse. As a result of the operation, either only the affected section of the colon or the entire colon can be removed. In addition, an artificial bowel outlet is regularly created.

A low-fiber diet and sufficient fluid intake are recommended as self-help measures after the surgical treatment. The person concerned should also divide his regular meals into numerous smaller meals. The intestine can thus learn its normal function again as the disease progresses.

You can do that yourself

Consultation with a doctor is not always indicated. Sick people can sometimes cure an ailment like a cold on their own. Protection and rest help the body to recover. Toxic megacolon, on the other hand, is a serious and life-threatening condition. Self-therapy is excluded in this case.

An operation takes place regularly. Patients with the typical symptoms should seek medical treatment immediately. Self-measures promise no recovery. A mortality rate of about 50 percent does not allow self-treatment apart from scientific knowledge.

However, there are things you can do to help with recovery. Above all, relaxation and rest have a positive effect on healing. Sporting activities should be stopped completely immediately after an operation and then only started again gradually. The attending doctor will be happy to advise patients on this.

Diet also needs to be changed. Many small meals are advised. Low-fiber foods are preferable. After a treatment, the intestine first has to get used to its normal functions again. A sufficient and non-alcoholic liquid intake supports him in this. The transport of the chair can thus get going again.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.