Clinical and Experimental Gastroenterology (May 2020)
Toxic Megacolon: Background, Pathophysiology, Management Challenges and Solutions
Abstract
Jiten Desai,1 Mohamed Elnaggar,2 Ahmed A Hanfy,2 Rajkumar Doshi2 1Department of Internal Medicine, Nassau University of Medical Center, East Meadow, NY, USA; 2Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USACorrespondence: Rajkumar DoshiDepartment of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St W11, Reno, NV 89502, USATel +1 201 885 8992Email [email protected]: Toxic megacolon (TM) is one of the fatal complications of inflammatory bowel disease (IBD) or any infectious etiology of the colon that is characterized by total or partial nonobstructive colonic dilatation and systemic toxicity. It is associated with high morbidity and mortality, and surgical management is necessary for the majority of the cases. An accurate history and physical examination, plain radiographs of the abdomen, sigmoidoscopy, and, most important of all, awareness of the condition facilitate diagnosis in most cases. Operative intervention is warranted when massive hemorrhage, perforation, or peritonitis complicate the clinical scenario or medical therapy fails to control the disease. We sought to review the management challenges of TM and its possible management strategies in this article.Keywords: toxic megacolon, inflammatory bowel disease, management challenges and solutions for toxic megacolon, Clostridium difficile colitis, nitric oxide synthase
