Criteria for Toxic Megacolon

Q: All of the following are part of the diagnosis of Toxic Megacolon except?

A) Radiographic evidence of colonic distension 
B) Fever > 38ºC 
C) Neutrophilic leukocytosis > 20,500/microL 
D) Dehydration 
E) Electrolyte disturbances


Answer:  C

The criteria of Toxic Megacolon cannot be made without the radiographic evidence of colonic distension. Despite the availability of CT scan and ultrasound, the plain radiograph is vital to make the diagnosis. This is probably due to the fact that criteria was established almost 50 years ago and still valid and easy to use in clinical practice. Usually, the transverse or right colon is found to be dilated from 6 cm up to 15 cm on supine films. If radiographic evidence is present, it does not take much to confirm the diagnosis of toxic megacolon with the addition of the following.

 PLUS at least 3 of the following:

•Fever >38ºC
•Heart rate >120 beats/min
•Neutrophilic leukocytosis >10,500/microL (only mild elevation is required)
•Anemia

PLUS at least one of the following:

•Dehydration
•Altered sensorium
•Electrolyte disturbances
•Hypotension


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References:

1. Jalan KN, Sircus W, Card WI, et al. An experience of ulcerative colitis. I. Toxic dilation in 55 cases. Gastroenterology 1969; 57:68.

2. Fazio VW. Toxic megacolon in ulcerative colitis and Crohn's colitis. Clin Gastroenterol 1980; 9:389.