Toxic Megacolon

Leyla Azmoun, MD
Piran Aliabadi, MD
B Leonard Holman, MD

December 12, 1995

Presentation

A 57-year-old man, recently diagnosed as having ulcerative colitis, presented with persistent bloody diarrhea, increasing rectal pain and mild abdominal pain. He had a fever of 101 degrees, decreased bowel sounds, and a tense, mildly distended abdomen.

Imaging Findings

Supine and upright radiographs of the abdomen

Supine and upright plain radiographs of the abdomen show moderate dilation of the colon with loss of haustration in the descending colon (arrow). There are polypoid filling defects in the sigmoid and descending colon (arrows). Thickening of the wall of the colon indicating edema is also visible (arrow). There are no abnormal collections of gas or fluid outside of the GI tract.

Differential Diagnosis

Findings are consistent with ulcerative colitis and suggest toxic megacolon.

Diagnosis

Toxic megacolon

Discussion

Toxic megacolon is defined as dilation of the colon with fulminant colitis. The diagnosis is based on the clinical findings and abnormalities found on plain film. Barium enema is contraindicated in the case of toxic megacolon due to risk of perforation. CT is useful for follow-up of treatment of toxic megacolon and diagnosis of complications. Toxic megacolon can be seen as a complication of the following diseases:

ulcerative colitis
Crohn's disease
ischemic colitis
pseudomembranous colitis
amebiasis

Toxic megacolon is one of the most important complications of ulcerative colitis. Plain film of the abdomen is the primary imaging modality for diagnosis of toxic megacolon. Urgent medical treatment is the next step. Close observation for consideration of surgical treatment if medical treatment fails is a must.

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