Definition Toxic megabowel is a serious complication that can follow inflammation or infection of the large bowel. It causes marked enlargement of the bowel.
What is going on in the body? The bowel attaches to the rectum and anus. When the bowel becomes inflamed or infected, it may enlarge. Toxic megabowel describes a dangerous enlargement of the bowel. This may result in a life-threatening tear, or perforation, of the bowel.
What are the signs and symptoms of the condition? Symptoms of toxic megabowel may include:
On physical examination, the person looks quite ill. If a tear in the bowel has occurred, the person is likely to show signs of peritonitis. These signs may include a hard, rigid abdomen, and severe abdominal tenderness.
What are the causes and risks of the condition? The two primary causes of this condition are infections and inflammation. Inflammation is usually due to a condition known as inflammatory bowel disease (IBD). IBD can cause inflammation in the lining of the bowel for unknown reasons.
Medications used to control diarrhoea may also raise the risk of this condition in some cases. Low blood levels of potassium may do the same.
What can be done to prevent the condition? Early treatment of inflammatory bowel disease flare-ups may help prevent toxic megabowel. Medications to control diarrhoea should be used with caution when the bowel is inflamed or infected.
How is the condition diagnosed? The person's medical history and a physical examination are important in making the diagnosis. Abdominal x-rays can help confirm the diagnosis by showing a severely enlarged bowel.
What are the long-term effects of the condition? Toxic megabowel is life-threatening and may result in death. A person who develops a tear in the bowel will require surgery. A colectomy, the removal of part or all of the bowel, may be needed.
What are the risks to others? Toxic megabowel is not contagious and poses no risks to others.
What are the treatments for the condition? Once toxic megabowel is diagnosed, the person is asked not to eat or drink anything. Fluids and salt are given intravenously (IV), which means through a vein. If the person's blood count is low, blood transfusions may be given. gastric suctioning, a procedure in which a thin tube is used to remove stomach contents, can help reduce abdominal bloating. Antibiotics are usually given to kill bacteria. IV steroids, which are medications that reduce inflammation, may also be given.
In some cases, food is given intravenously. Someone with a suspected or known tear of the bowel will need surgery to remove part or all of the bowel.
What are the side effects of the treatments? Antibiotics can cause stomach upset and allergic reactions. Other side effects vary depending on the medication that is used. Surgery carries the risk of bleeding, infection, and allergic reactions to anaesthesia.
What happens after treatment for the condition? If the person recovers completely from toxic megabowel, no further treatment may be needed. Some people have no long-standing problems from this condition, especially if surgery is not needed. However, a person with inflammatory bowel disease will need lifelong treatment.
Those who had surgery for this condition need follow-up visits with the surgeon to ensure proper healing. Sometimes a second operation is needed in the future.
How is the condition monitored? After recovery from toxic megabowel, the person will need no further monitoring if the cause was an infection. A person with inflammatory bowel disease will need lifelong monitoring. Any new or worsening symptoms should be reported to the doctor.
Author: Minot Cleveland, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
