Toxic Megacolon: Management Challenges

Toxic Megacolon (TM) is a non-obstructive dilatation of the colon, either total or segmental, associated with systemic toxicity. Even though it is best known as a consequence of Inflammatory Bowel Diseases (IBD) and it is mostly related to Ulcerative Colitis (UC), it may be also a complication of other conditions, such as infectious diseases. In fact, the epidemiology of TM has lately changed: there has been a recent increase in the number of reports of TM associated with pseudomembranous colitis (PMC) and, hereupon, the Clostridium difficile has spread as one of the most important causes of TM. However, more precise data about the epidemiology of TM should be collected. Due to its systemic involvement, TM is a severe and life-threatening condition that still represents a big challenge for both physicians and surgeons. A multidisciplinary team should take care of the patient with a close monitoring and the surgeons should be involved from the very onset of TM, since it often requires a surgical treatment and the establishment of the right timing to perform it can be very difficult. Even though the mainstay of the therapy is the treatment of the underlying cause of TM, the milestones of the current therapy are mostly extrapolated from old trials about IBD patients, especially those who are affected by severe UC. Therefore, one of the main difficulties about management of TM is the lack of recent randomized clinical trials comparing different approaches to TM.