[Toxic megacolon--the position of the internist]

Toxic megacolon is a rare but typical complication of ulcerative colitis. But also every inflammatory bowel disease may be cause of toxic megacolon, including especially Crohn's colitis and pseudomembranous colitis (PMC). There is to mention, that PMC becomes more frequent and more important in the last years. Toxic megacolon is defined by radiological, clinical and labaratory criteria: colonic distension (<6 cm), fever, tachycardia, hypotension, electrolyte disturbances, leucocytosis and anemia. Intensive medical therapy is primarly the therapy of choice, but clinical parameters should be closely monitored. In patients with ulcerative colitis high dosis of corticosteroids are given intravenously. If there is no clinical improvement after 48 to 72 hours, colectomy is required. The use of alternative therapies like cyclosporine or infliximab has to be discussed as possible before toxic megacolon occurs.