Toxic Mega Colon & Perforation

The term "toxic" means that this complication occurs with infection or inflammation. As a toxic systematic reaction, you'll experience rapid heartbeat, fever, show high white blood cell counts in the body. Toxic megacolon can be triggered during a severe flare or a c difficile episode. Other things that increase risk are fast tapers of corticosteroids, also medications that slow down the bowel, like opioid use and Imodium. Overall risk of getting TMC is pretty low for uc patients as a whole, around 5 percent.

emedicine.medscape.com/article/181054-overview#a6

It puzzles me to this day how I didn't ever end up having a perforation or toxic mega colon considering I flared from moderate to severe for 23 years straight through with my crohn's colitis, especially when you consider crohn's tends to affect the many layers of the intestinal lining where uc stays on the surface.

This IBD is absolutely insane!

Wow, that must be the reason you had most of your large intestine removed...I wasn't sure on the why.

iPoop said...
Wow, that must be the reason you had most of your large intestine removed...I wasn't sure on the why.

Nah, IV steroids knocked it on the head, at least for a while. I don't know what US hospitals are like, but in UK hospitals nobody tells you anything about what's going on. I was in for 9 days and lucky to see a doctor for 30 seconds in the mornings. I had no idea how close I was to surgery. I only found out from my GI later on that my surgeon had wanted to operate and had an argument with my GI about it - he wanted to give the Remicade more time to work. He also printed out the results of an abdominal x-ray for me which said I had a dilated colon consistent with the appearance of toxic megacolon - again, nobody at the hospital had told me anything about that.

After that episode I was hospitalised a few more times over the following year, but not sure if I ever got toxic megacolon again - going from symptoms alone, I'd say it was possible. Each time IV steroids rescued me but I ended up becoming hopelessly steroid-dependent. I failed Remicade and Humira and Etyvio wasn't out then. After a flare-up around the time of my birthday (Jan 2013) I decided I couldn't hack this crap anymore and booked surgery. The pathology report showed that I had severe acute and chronic inflammation throughout every bit of my colon - there wasn't any part of it that was disease-free.

So technically my first surgery was elective but even my GI conceded afterwards I probably should have had it two years earlier than I did. I was living on borrowed time and relying exclusively on steroids, since nothing else worked.

Pluot said...
I have personally seen patients who thought they were in remission come into the hospital with fulminant colitis/toxic megacolon, but it is not common to say the least (it is a small percentage of the 2.5% of patients who ever get it). It is also more common in Crohn's than in UC patients because rectal inflammation is "harder to ignore," so to speak.

Can't believe anyone can get toxic megacolon and still think they're well and healthy, I just can't. I was deathly ill with incredibly high spiking temperatures. Maybe they thought they had an infection instead.

That's interesting about toxic megacolon being more common in Crohn's than in UC - thought it was the other way round. I do agree that rectal inflammation is harder to ignore. Colitis without rectal involvement is relatively piss-easy by comparison, particularly if it's not too severe.

Oops sorry. Braindeadness and lack of sleep made me misunderstand your post, but I get you now. Yeah, anecdotally there's a few folks on the Crohn's board who report having few to no symptoms and then finding out they have active inflammation or have a small bowel obstruction out of the blue. There's one woman with apparently quite severe pancolitis who has no diarrhoea, urgency, etc. - rectal pain is, and was, her only symptom of anything wrong.

I must admit, I'm a bit baffled by those who have active disease but no symptoms. I suppose the closest I came to that was when I was first diagnosed - very few symptoms then really, amazed I got a diagnosis at all, let alone Crohn's. Sadly it wasn't to last.