Toxic megacolon medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]


Medical therapy of toxic megacolon include stablizing the patient, decompression and medications. Medications for toxic megacolon include corticosteroids, immunosuppresants and antibiotics.

Medical Therapy

Medical therapy of Toxic megacolon include:[1][2][3][4][5][6]

  • 1. General considerations
  • 2. Decompression
    • 2.1. Rectal tube
    • 2.2. Nasogastric or long naso-intestinal tube
    Note: Long intestinal tubes are considered to be more effective than naso-gastric tubes in colonic decompression but should be placed into the ileum under fluoroscopic guidance.
    • 2.3. Repositioning maneuvers[7][8]
    Note: Maneuver 1: Asking patients to roll into the prone position for 10-15 minutes every 2-3 hours and encourage them to pass gas.
    Note: Maneuver 2: Turning to the prone knee-elbow position, which moves the rectum to the highest point in the body.
  • 3. Medical management


  1. 1.0 1.1 Gan, S. Ian; Beck, P. L. (2003). "A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management". The American Journal of Gastroenterology. 98 (11): 2363–2371. doi:10.1111/j.1572-0241.2003.07696.x. ISSN 0002-9270.
  2. Autenrieth DM, Baumgart DC (2012). "Toxic megacolon". Inflamm. Bowel Dis. 18 (3): 584–91. doi:10.1002/ibd.21847. PMID 22009735.
  3. Farkouh E, Wassef R, Allard M, Atlas H (1983). "Toxic megacolon in inflammatory colon disease". Union Med Can (in French). 112 (11): 1014–6. PMID 6665937.
  4. Gonzáles Lara V, Pérez Calle JL, Marín Jiménez I (2003). "Approach to toxic megacolon". Rev Esp Enferm Dig. 95 (6): 422–8, 415–21. PMID 12918536.
  5. Koudahl G, Kristensen M (1975). "Toxic megacolon in ulcerative colitis". Scand. J. Gastroenterol. 10 (4): 417–21. PMID 1153934.
  6. Meyers S, Janowitz HD (1978). "The place of steroids in the therapy of toxic megacolon". Gastroenterology. 75 (4): 729–31. PMID 213344.
  7. Present DH, Wolfson D, Gelernt IM, Rubin PH, Bauer J, Chapman ML (1988). "Medical decompression of toxic megacolon by "rolling". A new technique of decompression with favorable long-term follow-up". J. Clin. Gastroenterol. 10 (5): 485–90. PMID 3183326.
  8. Panos MZ, Wood MJ, Asquith P (1993). "Toxic megacolon: the knee-elbow position relieves bowel distension". Gut. 34 (12): 1726–7. PMC 1374472. PMID 8282262.
  9. Strong SA (2010). "Management of acute colitis and toxic megacolon". Clin Colon Rectal Surg. 23 (4): 274–84. doi:10.1055/s-0030-1268254. PMC 3134807. PMID 22131898.
  10. Bolton RP, Culshaw MA (1986). "Faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to Clostridium difficile". Gut. 27 (10): 1169–72. PMC 1433873. PMID 3781329.