Fulminant Colitis and Toxic Megacolon

Abstract

Toxic megacolon may be a complication of various forms of fulminant colitis. The high mortality associated with unattended toxic megacolon signifies the impor tance of early detection. The removal of potential pre cipitating factors, along with aggressive medical sup port, may prevent the need for surgical intervention. Treatment of patients with toxic megacolon should in clude immediate resuscitative measures, use of nasogas tric suction, and administration of antibiotic and intrave nous steroids. Vigorous replacement of fluid and blood to stabilize and maintain blood pressure and an ade quate central venous pressure is critical. A period of observation of 24 to 48 hours should be undertaken, during which time clinical assessment and serial radio graphs should be used to gauge improvement. If there is either deterioration or no improvement, surgery should be performed without delay.