Complications of Ulcerative Colitis: Toxic Megacolon

Toxic megacolon is a life-threatening complication that occurs among those afflicted with ulcerative colitis or Crohn's Disease. A distended or inflated colon that expands at a very fast rate characterizes megacolon. Some of the causative factors include the severity of ulcerative colitis, medications that may be damaging to the colon and procedures such as a barium enema in which the colon is filled with barium and then x-rayed. During a barium enema examination the colon may also be filled with air to allow a radiologist to study it in greater detail. Other causes may include the over usage of narcotic pain drugs, anti-anxiety medications and anti-depressants. Some over-the-counter medications such as those used to treat and prevent diarrhea can also be a factor. It is important for someone with inflammatory bowel disease to consult his or her doctor before taking any medicine even if it is an over-the-counter drug.

Symptoms

Some symptoms of toxic megacolon include abdominal pain, swelling or tenderness of the abdomen, fever, nausea and vomiting, dehydration, rapid heart rate and septic shock. Septic shock is a very serious infection in the bloodstream and is sometimes referred to as a poisoning of the blood. It can cause failure of several organs, including the liver, kidneys and lungs, and has a very high death rate of over 50%. Septic shock requires hospitalization and is usually treated in the intensive care unit where a patient can be monitored on a 24-hour basis. Not all patients that develop toxic megacolon will become septic. It can however cause someone to become mentally unstable and so is something that a patient should be made aware of and educated about, as it is a possibility. It is important to remember that not all patients will develop septic shock.

Treatment

Tests to diagnose toxic megacolon will consist of blood work, x-rays and possibly a colonoscopy. The goal of treatment is to decrease the size of the distended colon and to prevent perforation, a tear in the lining or wall of the colon. A patient will be given fluids to prevent dehydration, antibiotics to prevent sepsis and drugs such as steroids to try to decrease the size of the colon. If a patient does not show an improvement within 24 hours a colorectal surgeon will perform a colectomy in which the colon is removed. Toxic megacolon has a fatality rate of about 35% when it is left untreated. This number is significantly reduced, to about 5%, if it is caught in its early stages and treated right away.

Sources

www.webmd.com
www.ccfa.org
www.ostomates.org
Crohn's & Colitis Foundation of America