AM Report 12/6/2016: Toxic Megacolon

Risk factors for developing C. Diff associated diarrhea:


The pathogenesis of C. diff infection:


Treatment for C. diff associated diarrhea:


Two criteria necessary to distinguish toxic megacolon from other types of colonic distention:

  • Total or segmental non-obstructive colonic dilation
  • Systemic toxicity (not present in other forms of megacolon)

Causes of toxic megacolon:

  • Inflammatory
  • Infectious
  • Other (volvulus, obstructive colon cancer, etc.)


Diagnosis of toxic megacolon:

1) Radiographic evidence

2) Main Criteria (need 3):

  • Fever
  • Tachycardia
  • Leukocytosis
  • Anemia

3) Minor Criteria (need 1):

  • Dehydration
  • Altered level of consiousness
  • Electrolyte imbalances
  • Hypotension

* The overall clinical condition is more important than the absolute width of the dilated segment

Treatment of toxic megacolon:

  • Initial therapy is medical, which is successful in preventing surgery in up to 50% of patients
  • Specific medical therapies are aimed at the underlying etiology (i.e. steroids in IBD)

In patient’s with toxic megacolon due to C. diff colitis:

  • Stop any offending antibiotics
  • Start C. diff treatment: PO vancomycin 500 mg QID and IV metronidazole 500 mg Q8H
  • Colectomy in patient’s who fail to improve within 48 – 72 hours or show evidence localized perforation

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