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Toxic Megacolon in Fulminating Disease

Henry J. Tumen, MD
JAMA. 1965;191(10):838-842. doi:10.1001/jama.1965.03080100056012.
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Toxic megacolon, occurring in fulminating ulcerative colitis, has been called the "most dreaded complication of ulcerative colitis."1 This is a valid generalization. No complication of the disease demands prompter evaluation, more constant vigilance, and more skillful management. It results from the maximum insult to the colon by the disease and by the severe damage to the muscular coats of the colon by the active inflammatory process. Degeneration and destruction of the myenteric plexuses and ganglia of the colon have also been described so that the designation "toxic megacolon" has been suggested.2 It is not certain, however, that damage to the nerve plexuses is an essential pathogenic factor. Basically, the condition is one in which there is loss of effective colonic motility. Although it is logical to assume that this results from inflammatory and degenerative changes in the colonic wall, metabolic disturbances incident to the colitis, such as hypoproteinemia

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