Medical management of toxic megacolon

Toxic megacolon is a severe form of acute severe colitis characterized by systemic toxicity and dilatation of colon. It is associated with a high rate of colectomy and could be potentially fatal unless treated urgently with intensive medical therapy and, in many cases, colectomy. Patients with toxic megacolon need to be monitored closely by gastroenterologists and colorectal surgeons. Medical management needs to be intensive with intravenous corticosteroids and with infliximab or ciclosporin in selected patients. Failure of medical treatment should lead to early urgent colectomy. Patients with acute severe colitis should be treated early and risk factors for development of toxic megacolon managed proactively to prevent development of toxic megacolon.