Editing Toxic megacolon (section)

==Treatment==
The objective of treatment is to decompress the bowel and to prevent swallowed air from further distending the bowel. If decompression is not achieved or the patient does not improve with medical management, surgery is indicated. When surgery is required the recommended procedure is a [[colectomy]] (surgical removal of all or part of the colon) with end [[ileostomy]].<ref>{{cite journal |last= Seltman |first= AK |date= December 2012 |title= Surgical Management of ''Clostridium difficile'' Colitis |journal= Clinics in Colon and Rectal Surgery |volume= 25 |issue= 4 |pages= 204–9 |pmid= 24294121 |pmc= 3577611 |doi= 10.1055/s-0032-1329390}}</ref> Fluid and electrolyte replacement help to prevent dehydration and shock. Use of [[corticosteroid]]s may be indicated to suppress the [[inflammation|inflammatory]] reaction in the colon if megacolon has resulted from active inflammatory bowel disease. [[Antibiotics]] may be given to prevent [[sepsis]].<ref name= "Autenrieth2011">{{cite journal |last1= Autenrieth |first1= DM |last2= Baumgart |first2= DC |title= Toxic megacolon |journal= Inflammatory Bowel Diseases |date= August 2011 |doi= 10.1002/ibd.21847 |pmid= 22009735 |volume=18 |issue= 3 |pages=584–91|s2cid= 32866477 }}</ref>

Patients with severe colitis should be hospitalized for further care beyond initial tests. Treatment includes IV fluids and electrolytes to prevent dehydration, blood transfusions to keep hemoglobin above 9 g/dL, low-dose heparin to prevent blood clots, nutritional support if malnourished, and IV antibiotics if infection is suspected. Medications like anticholinergics, antidiarrheals, NSAIDs, and opioids must be stopped, as they can trigger toxic megacolon or worsen the illness. Patient monitoring should include tracking bowel movements, temperature, heart rate, and frequent blood tests. Daily physical exams are necessary to check for abdominal pain or signs of worsening, with even closer monitoring for those with toxic megacolon.<ref>{{Cite journal |last=Strong |first=Scott |date=December 2010 |title=Management of Acute Colitis and Toxic Megacolon |journal=Clinics in Colon and Rectal Surgery |language=en |volume=23 |issue=4 |pages=274–284 |doi=10.1055/s-0030-1268254 |pmid=22131898 |pmc=3134807 |issn=1531-0043}}</ref>

In cases of IBD-related toxic megacolon, sulfasalazine or 5-ASA compounds may be used after the initial attack resolves, although evidence for their benefit during the acute phase is limited. Glucocorticoids, such as hydrocortisone or methylprednisolone, are the first-line treatment and work by reducing nitric oxide production, helping to decrease colon swelling without increasing the risk of perforation. If there is no response to steroids within three days, cyclosporine or infliximab can be considered. Cyclosporine inhibits T-cell activity to reduce inflammation but is mainly effective in ulcerative colitis and should be used cautiously in elderly or high-risk patients. Infliximab blocks TNF-α to control inflammation and is effective in steroid-resistant cases, often achieving clinical improvement within a week and promoting long-term remission.<ref name=":2" />