Toxic megacolon

Key points• Toxic megacolon is a potentially life-threatening condition, most commonly caused by inflammatory bowel disease • Timely recognition of the disease and intervention is critical to avoid perforation • Guidelines recommend contrast CT imaging as the preferred investigation for patients in whom a concern about toxic megacolon exists • Surgery is indicated for patients with haemodynamic instability, in the presence of perforation, necrosis, or full thickness ischaemia, or for patients refractory to initial medical measures