Toxic dilatation of the colon

Toxic megacolon is a potentially fatal condition that represents the end of a spectrum of severe colitis. Typically, a complication of ulcerative colitis, it is increasingly a consequence of infective colitis. Diagnosis of toxic megacolon requires radiographic evidence of a dilated colon and tachycardia or fever in a patient with severe colitis of any cause. Unprepared flexible sigmoidoscopy should be performed on admission to confirm colitis and exclude complications such as cytomegalovirus infection. CT scanning is more sensitive than plain films for detecting perforation. Joint management between surgeons and physicians is fundamental. Medical therapy includes steroids, antibiotics, fluid and electrolyte management. Up to half respond to medical treatment. Colectomy is indicated if dilatation persists beyond the first 24 hours of admission. Delayed decision-making increases the likelihood of perforation with a concomitant rise in morbidity and mortality. © 2006 Elsevier Ltd. All rights reserved.