Related Experiment Video
Updated: Jul 4, 2026
Non-invasive Assessment of the Efficacy of New Therapeutics for Intestinal Pathologies Using Serial Endoscopic Imaging of Live Mice
Published on: March 10, 2015
Toxic megacolon in children with inflammatory bowel disease: clinical and radiographic characteristics
Eric I Benchimol1, Dan Turner, Erika H Mann
1Division of Gastroenterology, Hepatology & Nutrition, The Hospital of Sick Children, Toronto, Canada.
Insights
Toxic megacolon (TMC) in children with inflammatory bowel disease (IBD) presents with fever and dehydration, not altered consciousness. A colonic diameter of 56 mm or more strongly suggests TMC in pediatric IBD patients.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Colorectal Surgery
Background:
- Toxic megacolon (TMC) is a severe complication of inflammatory bowel disease (IBD), characterized by colonic dilation.
- This study focuses on the clinical and radiological features of TMC specifically in pediatric IBD patients.
Purpose of the Study:
- To assess the clinical and radiological characteristics of toxic megacolon in children diagnosed with inflammatory bowel disease.
- To compare these characteristics with a control group of pediatric IBD patients without TMC.
Main Methods:
- Systematic search for pediatric IBD patients with TMC, matched by age to controls without TMC.
- Conditional logistic regression used to compare clinical characteristics and outcomes.
- Abdominal X-rays analyzed by blinded radiologists to compare findings between TMC cases and controls.
Main Results:
- Fever, tachycardia, dehydration, and electrolyte abnormalities were more prevalent in pediatric TMC cases.
- Radiological findings like air-fluid levels, intestinal thickening, and abnormal colonic haustra were more common in TMC.
- A transverse colon luminal diameter of ≥56 mm demonstrated high sensitivity (90%) and specificity (90%) for diagnosing TMC.
Conclusions:
- Colonic dilatation ≥56 mm, coupled with clinical signs, strongly indicates TMC in children with IBD.
- Mental alteration and hypotension appear less frequent in pediatric TMC compared to adults.
- Pediatric TMC is linked to adverse outcomes, including high rates of corticosteroid failure and colectomy.
Background:
Toxic megacolon (TMC) denotes a rare clinical syndrome accompanied by colonic dilatation, and is a serious complication of inflammatory bowel disease (IBD). This study assessed the clinical and radiologic characteristics of TMC in children with IBD.
Methods:
A systematic search identified patients with IBD-associated TMC and matched them by age to controls with ulcerative colitis without evidence of TMC. Clinical characteristics and outcomes were compared with conditional logistic regression. Abdominal X-rays were interpreted by two blinded radiologists and findings were compared with controls.
Results:
Ten children with TMC (median age 12.6 [7.3-15.5] yr) were matched with 20 controls (median age 12.8 [6.8-15.2] yr). Altered level of consciousness and hypotension were rare in children with TMC. Fever (P= 0.005), tachycardia (P= 0.0001), dehydration (P= 0.01), and electrolyte abnormalities (P= 0.0002) were more common in children with TMC than controls. Air-fluid levels (P= 0.005), intestinal thickening (P= 0.006), and abnormal colonic haustra (P= 0.012) were more commonly seen on X-rays of TMC cases. Transverse colon luminal diameter >or=56 mm was strongly suggestive of TMC (sensitivity 90%, specificity 90%, area under the ROC curve 0.91). No child with TMC died and 70% required colectomy during admission. Two of the three with intact colons at discharge required second-line therapy during the subsequent year.
Conclusions:
Colonic dilatation >or=56 mm in children with IBD strongly suggests TMC, if clinical signs are present. Mental alteration and hypotension may be less common in children than in adults. TMC in children with IBD is associated with poor outcome, with a high rate of corticosteroid failure.
Related Concept Videos
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:20Inflammatory Bowel Disease IV: Clinical Manifestations
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by transmural...
01:26Inflammatory Bowel Disease I: Introduction
01:20Inflammatory Bowel Disease II: Ulcerative Colitis
01:25Inflammatory Bowel Disease III: Crohn's Disease