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Toxic megacolon
 
 
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Toxic megacolon (megacolon toxicum) is a life-threatening complication of other intestinal conditions. It is characterized by a very dilated colon
Colon (anatomy)

The colon is the last portion of the digestive system in most vertebrates; it extracts water and salt from feces before they are defecation from the body....
 (megacolon
Megacolon

Megacolon is an abnormal dilatation of the colon that is not caused by mechanical obstruction. The dilatation is often accompanied by a paralysis of the peristalsis movements of the bowel....
), accompanied by abdominal distension (bloating
Bloating

Bloating is any abnormal general swelling, or increase in diameter of the abdomen area. As a symptom, the patient feels a full and tight abdomen, which may cause abdominal pain sometimes accompanied by borborygmus....
), and sometimes fever
Fever

Fever is a frequent medical sign that describes an increase in internal body temperature to levels above normal. Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1?2 ?C ....
, abdominal pain
Abdominal pain

Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom....
, or shock.

Toxic megacolon is usually a complication
Complication (medicine)

Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathology changes, become widespread throughout the body or affect other organ systems....
 of inflammatory bowel disease
Inflammatory bowel disease

In medicine, inflammatory bowel disease is a group of inflammation conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.....
, such as ulcerative colitis
Ulcerative colitis

Ulcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon , that includes characteristic Peptic ulcer, or open sores, in the colon....
 and, more rarely, Crohn’s disease, and some infections of the colon. Other forms of megacolon exist and can be congenital (present since birth, such as Hirschsprung's disease
Hirschsprung's disease

Hirschsprung's disease, or congenital aganglionic megacolon, involves an enlargement of the colon , caused by bowel obstruction resulting from an ganglion section of bowel that starts at the anus and progresses upwards....
)


There may be signs of septic shock
Septic shock

Septic shock is a serious medicine condition caused by decreased tissue perfusion and oxygen delivery as a result of infection and sepsis, though the microbe may be systemic or localized to a particular site....
.






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Toxic megacolon (megacolon toxicum) is a life-threatening complication of other intestinal conditions. It is characterized by a very dilated colon
Colon (anatomy)

The colon is the last portion of the digestive system in most vertebrates; it extracts water and salt from feces before they are defecation from the body....
 (megacolon
Megacolon

Megacolon is an abnormal dilatation of the colon that is not caused by mechanical obstruction. The dilatation is often accompanied by a paralysis of the peristalsis movements of the bowel....
), accompanied by abdominal distension (bloating
Bloating

Bloating is any abnormal general swelling, or increase in diameter of the abdomen area. As a symptom, the patient feels a full and tight abdomen, which may cause abdominal pain sometimes accompanied by borborygmus....
), and sometimes fever
Fever

Fever is a frequent medical sign that describes an increase in internal body temperature to levels above normal. Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1?2 ?C ....
, abdominal pain
Abdominal pain

Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom....
, or shock.

Toxic megacolon is usually a complication
Complication (medicine)

Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathology changes, become widespread throughout the body or affect other organ systems....
 of inflammatory bowel disease
Inflammatory bowel disease

In medicine, inflammatory bowel disease is a group of inflammation conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.....
, such as ulcerative colitis
Ulcerative colitis

Ulcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon , that includes characteristic Peptic ulcer, or open sores, in the colon....
 and, more rarely, Crohn’s disease, and some infections of the colon. Other forms of megacolon exist and can be congenital (present since birth, such as Hirschsprung's disease
Hirschsprung's disease

Hirschsprung's disease, or congenital aganglionic megacolon, involves an enlargement of the colon , caused by bowel obstruction resulting from an ganglion section of bowel that starts at the anus and progresses upwards....
)

Symptoms

  • Abdominal pain
    Abdominal pain

    Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom....
  • Abdominal bloating
    Bloating

    Bloating is any abnormal general swelling, or increase in diameter of the abdomen area. As a symptom, the patient feels a full and tight abdomen, which may cause abdominal pain sometimes accompanied by borborygmus....
  • Abdominal tenderness
  • Fever
    Fever

    Fever is a frequent medical sign that describes an increase in internal body temperature to levels above normal. Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1?2 ?C ....
  • Tachycardia
    Tachycardia

    The word tachycardia comes from the Greek words tachys and kardia .Tachycardia typically refers to a heartrate that exceeds the range of the normal resting heartrate, based upon age:...
     (rapid heart rate)
  • Dehydration
    Dehydration

    Dehydration is the removal of water from an object. In Physiology terms, it entails a relative deficiency of water molecules in relation to other dissolved solutes....


There may be signs of septic shock
Septic shock

Septic shock is a serious medicine condition caused by decreased tissue perfusion and oxygen delivery as a result of infection and sepsis, though the microbe may be systemic or localized to a particular site....
. A physical examination
Physical examination

File:Reeve 978.jpgPhysical examination or clinical examination is the process by which a health care provider investigates the body of a patient for sign of disease....
 reveals abdominal tenderness and possible loss of bowel sounds. An abdominal radiography
Radiography

Radiography is the use of X-rays to view unseen or hard-to-image objects. The main diagnostic purposes of X-rays are to see inside one's body, most commonly the bones which can be viewed at an optimum resolution ....
 shows colonic dilation. There is usually an elevated white blood cell
White blood cell

White blood cells , or leukocytes , are cell of the immune system defending the body against both infectious disease and foreign materials....
 count. Severe sepsis may present with hypothermia or leukopenia
Leukopenia

Leukopenia is a decrease in the number of circulating white blood cells in the blood. As the principal function of white cells is to combat infection, a decrease in the number of these cells can place patients at increased risk for infection....
.

Treatment

The objective of treatment is to decompress the bowel and to prevent swallowed air from further distending the bowel. If decompression is not achieved or the patient does not improve within 24 hours, a colectomy
Colectomy

Colectomy consists of the surgery resection of any extent of the large intestine ....
 (surgical removal of all or part of the colon) is indicated. Fluid and electrolyte replacement help to prevent dehydration and shock. Use of corticosteroid
Corticosteroid

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiology systems such as stress , immune system and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior....
s may be indicated to suppress the inflammatory reaction in the colon if megacolon has resulted from active inflammatory bowel disease. Antibiotics may be given to prevent sepsis
Sepsis

Sepsis, is a serious medicine condition characterized by a whole-body Inflammation state and the presence of a known or suspected infection. (a severe infection).

Prognosis

If the condition does not improve, there is a significant risk of death. In case of poor response to conservative therapy a colectomy is usually required. This may involve all or part of the colon being removed, with the resulting option of anastomosis or colostomy. Colostomy carries far less risk of infection and post-operative complications because the risk of deterioration of sutures within the intestinal tract (as a result of anastomosis) is not present. The risk of death and shock has been reported to be lower in children, however most children required colectomy in one case-control study .

Complications

  • Sepsis
  • Shock
  • Perforation of the colon


Emergency action may be required if severe abdominal pain develops -- particularly if it is accompanied by fever, rapid heart rate, tenderness when the abdomen is pressed, bloody diarrhea
Diarrhea

In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
, frequent diarrhea, or painful bowel movements.

External links

  • . National Institutes of Health. Used as the public domain source for this article. Update on 1/26/2004 by: Sreeni Jonnalagadda, M.D., Interventional and Pancreatobiliary Endoscopy, Washington University School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network.