Toxic megacolon is a serious complication of
inflammatory bowel disease, thus its prevention should be performed thoroughly. In patients with severe
colitis refractory to maximal oral and topical
therapy or who presents with toxicity, intravenous
steroids are obligatory. If there is failure to achieve significant improvement within 7-10 days
colectomy or treatment with intravenous
cyclosporine or
azathioprine are mandatory. In addition to maximal medical
therapy as for severe
colitis including broad spectrum
antibiotics, patients with
toxic megacolon should be kept nil per os, with small bowel
decompression tube (if a small bowel
ileus is present) and rotated into the prone or knee-elbow position frequently (evacuation of bowel gas). Any clinical, laboratory, or radiological deterioration require immediate
colectomy. The duration of medical treatment of
megacolon is controversial if no significant improvement is noted. Some experts support surgery within 72 hours, others take a more observing position if no toxic symptoms are present, but some advocate surgery within 24 hours.