Toxic Megacolon

Fulminant colitis/ Toxic megacolon

This has arbitrarily been defined as having three or more of the following criteria present: 
1)tachycardia greater than 100, 

2)leukocytosis greater than 12,000/dL3, 

3)hypoalbuminemia less than 3 g/dL3, 

4)a temperature greater than 38°C, or 

5)a diameter of the transverse colon on a plain abdominal radiograph greater than 5 cm. 

Three or more of these criteria meet the definition of toxic megacolon; 
note that a “megacolon” does not need to be present in order to meet this definition. Thus, the definition of toxic megacolon merely refers to a patient who is septic due to very severe colitis. Toxic megacolon can be present not only from severe UC but also due to severe Crohn colitis or severe infectious or ischemic colitis.


Truelove and Witts is a popular classification scheme (Severity of Ulcerative Colitis) that characterizes patients by the severity of their diarrhea, the presence of blood in stool, the presence of fever, tachycardia, anemia, or an elevated erythrocyte sedimentation rate.


Endoscopic findings of Crohn’s disease 

Crohn disease is more characterized by deeper punched-out appearing ulcerations. 

In these cases, there are often longer serpiginous ulcerations covered with fibrin. 

These can oftentimes extend longitudinally along the lumen of the bowel, in which case they are sometimes referred to as “bear claw” ulcerations . 

In Crohn disease, in many cases, the inflammation is more patchy and there can be discontinuous inflammation (i.e., skip areas), with areas of intervening normal appearing mucosa.

In many cases, Crohn disease ulcers are worse on the mesenteric side of the bowel. 

Regarding the distribution of Crohn disease, the most common site of involvement in nearly half of patients is ileocolic, followed by colonic involvement. 

Crohn disease can also affect the small bowel or upper GI tract.

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