Toxic megacolon: Causes, Symptoms, Treatment and Cost

Toxic megacolon is an acute, life-threatening complication of inflammatory bowel disease (IBD) that causes a person's colon (large intestine) to become dangerously distended and inflamed.

• Primary Toxic Megacolon: This uncommon and sometimes deadly consequence of inflammatory bowel disease (IBD) is brought on by the colon's excessive response to inflammation.
• Secondary Toxic Megacolon: It is caused by a variety of conditions other than IBD, including infection, colorectal cancer, ischemic colitis and medications such as certain antibiotics.
• Ischemic Toxic Megacolon: It is caused by poor blood supply to the large intestine resulting in an inability to maintain normal bowel contractions and can lead to perforation or rupture of the colon.
• Allergic Toxic Megacolon: It is an acute severe form of allergic reaction that can occur after taking certain medications, including antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids such as codeine or morphine sulphate.

It is most commonly caused by severe ulcerative colitis, an inflammatory bowel disease marked by chronic inflammation in the large intestine, or by pseudomembranous colitis, an infection caused by the overgrowth of C. difficile bacteria in the colon. Other causes can include:

• Intestinal obstruction
• Crohn’s disease
• Toxic ingestion of medications or chemicals
• Radiation therapy to the abdomen or pelvic region
• Other serious medical conditions.
• In certain circumstances, no reason can be found.

• Abdominal pain and cramping: Pain and cramping in the abdominal region may vary from minor to severe and are sometimes accompanied by feelings of sickness and vomiting. The lower right side of the abdomen is often affected by this condition.
• Abdominal distention: The abdomen will become visibly swollen due to the accumulation of gas and fluid in the intestine.
• Diarrhoea or constipation: Diarrhoea is more common but constipation can occur as well, depending on the cause of toxic megacolon.
• Fever: This can indicate an infection or inflammation in the colon that is causing toxicity.
• Dehydration: This can occur due to excessive diarrhoea or vomiting, leading to low blood pressure, rapid heart rate, dizziness, fatigue, confusion and dark coloured urine.
• Shock: This is a life-threatening complication that develops when sepsis occurs due to infection in the colon or other organs affected by toxic megacolon. Symptoms include extreme confusion, rapid breathing and heart rate, cold hands and feet and low blood pressure.

• Maintain a Healthy Diet: Consuming a nutritious and balanced diet that includes lots of fruits, vegetables, whole grains, and lean meats may help decrease inflammation and improve symptoms of inflammatory bowel disease (IBD).
• Avoid Trigger Foods: Certain foods may worsen IBD symptoms, such as dairy products, processed foods, fried foods, and spicy foods.If you want to lower your chances of getting toxic megacolon, avoiding the foods on this list is your best bet.
• Take Medications as Prescribed: It is important to take medications as prescribed by your doctor to keep the inflammation in the intestines under control and prevent toxic megacolon from developing.
• Practice Stress Management: Stress can worsen IBD symptoms, so it is important to practise stress management techniques like yoga, deep breathing exercises, and mindfulness meditation.
• Get Regular Check-Ups: Regular check-ups with your doctor can help to monitor your condition and catch any changes before they become serious problems that could lead to toxic megacolon.

• Abdominal X-ray: An abdominal X-ray can help to identify Toxic Megacolon by looking for signs of inflammation or widening of the large intestine. It can also detect any complications such as free air in the abdominal cavity, which can indicate a perforation in the colon.
• Abdominal Ultrasound: This imaging test can help to identify any abnormalities in the large intestine, such as an enlarged colon or signs of infection and inflammation.
• Colonoscopy: This procedure is used to view the inside of the colon and detect any areas that are inflamed or widened, which could be a sign of Toxic Megacolon.
• CT Scan: A CT scan uses X-rays and computers to create detailed images of the abdominal organs and help diagnose Toxic Megacolon by looking for enlarged colon, inflamed walls and other related complications.
• Blood Tests: Blood tests are used to measure levels of inflammatory markers in the blood that may be elevated in Toxic Megacolon, such as C-reactive protein (CRP). Other blood tests that may be performed include a complete blood count (CBC) to check for anaemia, electrolyte levels, liver function tests and white blood cell count (WBC).

• Septic shock: Toxic megacolon can cause the body’s organs to go into systemic shock, leading to a decrease in blood pressure, impaired organ function, shock-induced coma and even death.
• Perforation of colon: Toxic megacolon can cause the colon’s walls to stretch too thin and tear, resulting in severe leakage of intestinal contents and infections in the abdominal cavity.
• Electrolyte imbalance: Prolonged bouts of diarrhoea from toxic megacolon can lead to imbalances of electrolytes that can cause life-threatening arrhythmias and cardiac arrest.
• Disseminated intravascular coagulopathy (DIC): A condition where clots form throughout the circulatory system not just at the site of injury or infection, causing organ damage and clotting abnormalities due to excessive bleeding or clotting within organs such as the lungs or brain.
• Hypovolemic shock: Impaired circulation due to excessive fluid loss leading to a decrease in blood pressure that is not responsive to fluid replacement therapy.

• Ayurvedic herbs such as Amalaki (Emblica officinalis), Kutki (Picrorhiza kurroa) and Chirayata (Swertia chirata) are known to be beneficial in treating toxic megacolons.
• Herbal enemas like Triphala Guggulu, Trimad Churna, and Sutshekhar Ras can be used to cleanse the colon and reduce inflammation.
• Virechana therapy or purgation therapy can be used to cleanse the colon of toxins and restore healthy digestion.
• Abhyanga or oil massage with Ayurvedic oils like Ksheerabala Thailam, Mahanarayana Thailam, or Dhanwantharam Thailam can be used to reduce inflammation and improve circulation in the area.
• Herbal teas like Bael Paan, Neem Paan, Tulsi Paan can also help in reducing inflammation and detoxifying the body systemically.

• Probiotics: Probiotics can help to reduce inflammation in the colon and increase healthy bacteria levels, which can help to combat the toxic megacolon. Examples include yoghurt, kefir, sauerkraut, and kimchi.
• Fibre-Rich Foods: Eating fibre-rich foods can help to reduce inflammation in the digestive tract and may be beneficial for people with toxic megacolon. Examples of high-fibre foods include fruits, vegetables, legumes, nuts and seeds, whole grains, and beans.
• Prebiotics: Prebiotics may be able to lessen colon inflammation and balance out the good bacteria in the gut. Apples, oats, bananas, asparagus, artichokes, garlic, onions, and bananas are a few examples of foods high in prebiotics.
• Bone Broth: Bone broth is made by simmering animal bones for several hours until they are soft enough to consume as a soup or drinkable broth. The collagen in bone broth can be beneficial for reducing inflammation in the digestive tract and may also be helpful for treating toxic megacolon.
• Coconut Oil: Coconut oil contains medium chain triglycerides (MCTs) which are believed to have anti-inflammatory properties that may help reduce inflammation in the digestive tract associated with toxic megacolon. While treating toxic megacolon symptoms, it is advised to ingest 1 tablespoon of coconut oil daily as part of a healthy diet.

• High-fibre foods: High-fibre foods such as fruits, vegetables, nuts, seeds, and whole grains can cause abdominal pain and bloating and can worsen symptoms of toxic megacolon.
• Dairy products: Milk, cheese, and yoghurt are examples of dairy products that may be challenging to digest and may make IBD symptoms worse.It is best to avoid or limit dairy intake while dealing with toxic megacolon.
• Greasy or fried foods: Greasy or fried foods are not easily digested by the body, making them a poor choice for people with IBD who are dealing with toxic megacolon.
• Spicy foods: Spicy foods may cause abdominal discomfort and bloating in people with IBD due to their inflammatory properties. It is best to avoid hot spices like chilli peppers, cayenne pepper, jalapenos, etc., when managing a toxic megacolon.
• Alcohol: Alcohol consumption can worsen symptoms of IBD and make it difficult for the body to absorb nutrients properly which may further exacerbate symptoms of toxic megacolon.

• Total Colectomy: This is the most common surgery used to treat toxic megacolon. During this operation, the surgeon will remove both the colon and the rectum in their entirety. The remaining small intestine is then connected to an opening in the abdomen (called a stoma) to allow waste to be expelled from the body.
• Subtotal Colectomy: This procedure involves removing part of the colon and rectum, preserving some of the healthy tissue for better function and reducing the risk of short-bowel syndrome.
• Ostomy Creation: An ostomy is a surgical procedure that creates an artificial opening in the abdominal wall so that waste can be expelled from the body without passing through the digestive system. This procedure is sometimes used in cases where there is significant inflammation or narrowing in the large intestine that cannot be treated by other methods.
• Endoscopic Resection: Endoscopic resection involves using a scope with cutting tools to remove portions of an inflamed or narrowed colon or rectum. This procedure may be used when other treatments are not effective or when there is a risk of further damage to healthy tissue if surgery is performed.
• Laparotomy: In some cases, a laparotomy may be required to inspect and remove damaged portions of the colon or rectum through an incision made in the abdomen wall.

The best doctor to consult for a toxic megacolon is a gastroenterologist.

A gastroenterologist is a medical doctor who specialises in treating conditions that affect the digestive system, particularly the large intestine.

They can diagnose and treat toxic megacolon as well as provide long-term care for those with IBD.

• Antibiotics: Antibiotic medicines such as ciprofloxacin or metronidazole can be used to help resolve toxic megacolon, as well as prevent potentially fatal infections.
• Anti-inflammatories: It is possible that your physician may advise you to use non-steroidal anti-inflammatory drugs (NSAIDs), such as the pharmaceutical mesalazine, in order to alleviate the inflammation that is occurring in the colon.
• Corticosteroids: Steroids such as prednisone and budesonide can reduce inflammation and shrink inflamed tissue in the colon, relieving symptoms of toxic megacolon.
• Immunosuppressants: In some cases, immunosuppressant drugs such as azathioprine may be prescribed in order to reduce inflammation in the large intestine caused by inflammatory bowel disease (IBD).
• Biologic agents: In severe cases of IBD, biologic agents like infliximab may be prescribed to treat a flare-up of symptoms.

Depending on the severity of the ailment and how fast it is treated, recovery time from toxic megacolon may range anywhere from a few days to several weeks.

No, the results of the treatment for toxic megacolon are not permanent.

It is important for patients to continue to manage their symptoms and follow their doctor's instructions in order to prevent further complications.

• Diet: Monitor for dehydration and malnutrition, and replace electrolytes as needed. Patients should be placed on a low fibre, non-residue diet until there is improvement in bowel function.
• Medication: High-dose steroids may be prescribed to reduce inflammation and halt the compromised intestinal activity that leads to megacolon. Antibiotics may also be prescribed.
• Procedures: Depending on the diagnosis, colectomy (surgery to remove part or all of the colon) may be recommended as an additional treatment option for patients with severe toxic megacolon conditions or complications associated with it such as perforation or bleeding of the colon wall.
• Monitor vital signs: Patients should always have their temperature checked regularly along with blood pressure monitoring, observation of oxygen saturation levels, urine output and other lab tests according to physician's orders.

Generally, costs may include hospital stay charges, surgeon's fees, anaesthesia charges, medical tests and imaging studies, medications and any other related expenses.

On average, potential costs could range around Rs 50 thousand to Rs 75 thousand for diagnostic tests, medication and One day stay in the hospital.

Short-term side effects of Toxic megacolon treatments commonly include:

• Abdominal pain and cramping
• Nausea
• Diarrhoea.

Long-term side effects may include:

• Bowel obstruction
• Scarring of the colon wall
• Perforation of the colon
• Fistulas in the gut or fistulas in the urinary tract.

Other potential side effects may include fever, joint or muscle aches or pains, fatigue and anaemia due to vitamin B12 deficiency caused by inadequate absorption from damage to the intestine lining.

If you are suffering from any complications relating Toxic megacolon then you should consult a doctor nearby as they can cause complications like 'septic shock, intestinal perforation, etc' in which treatment courses can range from a few months to years depending on the severity of the situation.