Internal and Emergency Medicine

, Volume 13, Issue 6, pp 881–887 | Cite as

Incidence, features, in-hospital outcomes and predictors of in-hospital mortality associated with toxic megacolon hospitalizations in the United States

  • Rajkumar DoshiEmail author
  • Jiten Desai
  • Yash Shah
  • Dean Decter
  • Shreyans Doshi


Toxic megacolon (TM) is a potentially fatal condition characterized by non-obstructive colonic dilatation and systemic toxicity. It is most commonly caused by inflammatory bowel disease (IBD). Limited data for TM are available demonstrating incidence, in-hospital outcomes and predictors of mortality. We sought to investigate incidence, characteristics, mortality and predictors of mortality associated with it. Data were obtained from the Healthcare Cost and Utilization Project (HCUP)’s Nationwide Inpatient Sample (NIS) database from January 2010 through December 2014. An analysis was performed on SAS 9.4 (SAS Institute Inc., Cary, NC). Patients below 18 years were excluded. A mixed-effects logistic regression model was developed to analyze predictors of mortality. Thus, 8139 (weighted) cases of TM were diagnosed between 2010 and 2014. TM is more prevalent in women (56.4%) than in men (43.6%), with a mean age of onset at 62.4 years, affecting whites (79.7%) more than non-whites. The most common reason for hospital admission included IBD (51.6%) followed by septicemia (10.2%) and intestinal infections (4.1%). Mean length of stay was 9.5 days and overall in-hospital mortality was 7.9%. Other complications included surgical resection of the large intestine (11.5%) and bowel obstruction (10.9%). Higher age, neurological disorder, coagulopathy, chronic pulmonary disease, heart failure, and renal failure were associated with greater risk of in-hospital mortality. TM is a serious condition with high in-hospital mortality. Management of TM requires an inter-disciplinary team approach with close monitoring. Patients with positive predictors in our study require special attention to prevent excessive in-hospital mortality.


Epidemiology Inflammatory bowel disease In-hospital outcomes Predictors of mortality Toxic megacolon 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was not required as the data were obtained from NIS. It has deidentified hospitalization data.

Data availability statement

The data that support the findings of this study are openly available in Healthcare Cost and Utilization Project’s website at Reference Number: 19.

Supplementary material

11739_2018_1889_MOESM1_ESM.docx (105 kb)
Supplementary material 1 (DOCX 105 kb)


  1. 1.
    Bartram CI (1977) Radiology in the current assessment of ulcerative colitis. Gastrointest Radiol 1(4):383–392PubMedGoogle Scholar
  2. 2.
    Lennard-Jones JE, Ritchie JK, Hilder W, Spicer CC (1975) Assessment of severity in colitis: a preliminary study. Gut 16(8):579–584CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Tomita R, Tanjoh K, Fujisaki S, Fukuzawa M (2000) Peptidergic nerves in the colon of patients with ulcerative colitis. Hepatogastroenterology 47(32):400–404PubMedGoogle Scholar
  4. 4.
    Tomita R, Tanjoh K (1998) Role of nitric oxide in the colon of patients with ulcerative colitis. World J Surg 22(1):88–91 [discussion 92] CrossRefPubMedGoogle Scholar
  5. 5.
    Pons L, Droy-Lefaix MT, Bueno L (1992) Leukotriene D4 participates in colonic transit disturbances induced by intracolonic administration of trinitrobenzene sulfonic acid in rats. Gastroenterology 102(1):149–156CrossRefPubMedGoogle Scholar
  6. 6.
    Snape WJ Jr, Kao HW (1988) Role of inflammatory mediators in colonic smooth muscle function in ulcerative colitis. Dig Dis Sci 33(3 Suppl):65S–70SCrossRefPubMedGoogle Scholar
  7. 7.
    Autenrieth DM, Baumgart DC (2012) Toxic megacolon. Inflamm Bowel Dis 18(3):584–591. CrossRefPubMedGoogle Scholar
  8. 8.
    Hernandez-Rocha C, Naour S, Alvarez-Lobos M, Paredes-Sabja D (2012) Clostridium difficile associated infections: an updated view. Rev Chilena Infectol 29(4):434–445. CrossRefPubMedGoogle Scholar
  9. 9.
    Ausch C, Madoff RD, Gnant M, Rosen HR, Garcia-Aguilar J, Holbling N, Herbst F, Buxhofer V, Holzer B, Rothenberger DA, Schiessel R (2006) Aetiology and surgical management of toxic megacolon. Colorectal Dis 8(3):195–201. CrossRefPubMedGoogle Scholar
  10. 10.
    Greenstein AJ, Sachar DB, Gibas A, Schrag D, Heimann T, Janowitz HD, Aufses AH Jr (1985) Outcome of toxic dilatation in ulcerative and Crohn’s colitis. J Clin Gastroenterol 7(2):137–143CrossRefPubMedGoogle Scholar
  11. 11.
    Grieco MB, Bordan DL, Geiss AC, Beil AR Jr (1980) Toxic megacolon complicating Crohn’s colitis. Ann Surg 191(1):75–80CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Roys G, Kaplan MS, Juler GL (1977) Surgical management of toxic megacolon. Am J Gastroenterol 68(2):161–166PubMedGoogle Scholar
  13. 13.
    Hartong WA, Arvanitakis C, Skibba RM, Klotz AP (1977) Treatment of toxic megacolon. A comparative review of 29 patients. Am J Dig Dis 22(3):195–200CrossRefPubMedGoogle Scholar
  14. 14.
    Caprilli R, Vernia P, Colaneri O, Torsoli A (1976) Blood pH: a test for assessment of severity in proctocolitis. Gut 17(10):763–769CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Strauss RJ, Flint GW, Platt N, Levin L, Wise L (1976) The surgical management of toxic dilatation of the colon: a report of 28 cases and review of the literature. Ann Surg 184(6):682–688CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Danovitch SH (1989) Fulminant colitis and toxic megacolon. Gastroenterol Clin North Am 18(1):73–82PubMedGoogle Scholar
  17. 17.
    Klipfel AA, Schein M, Fahoum B, Wise L (2000) Acute abdomen and Clostridium difficile colitis: still a lethal combination. Dig Surg 17(2):160–163. CrossRefPubMedGoogle Scholar
  18. 18.
    Synnott K, Mealy K, Merry C, Kyne L, Keane C, Quill R (1998) Timing of surgery for fulminating pseudomembranous colitis. Br J Surg 85(2):229–231. CrossRefPubMedGoogle Scholar
  19. 19.
    Grundfest-Broniatowski S, Quader M, Alexander F, Walsh RM, Lavery I, Milsom J (1996) Clostridium difficile colitis in the critically ill. Dis Colon Rectum 39(6):619–623CrossRefPubMedGoogle Scholar
  20. 20.
    Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (2006) NIS database documentation archive. Rockville, MD. Accessed December 6, 2017
  21. 21.
    Patel N, Kalra R, Doshi R, Arora H, Bajaj NS, Arora G, Arora P (2018) Hospitalization rates, prevalence of cardiovascular manifestations, and outcomes associated with sarcoidosis in the United States. J Am Heart Assoc 7(2):e007844. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Doshi R, Shlofmitz E, Meraj P (2018) Comparison of outcomes and complications of transcatheter aortic valve implantation in women versus men (from the National Inpatient Sample). Am J Cardiol 121(1):73–77. CrossRefPubMedGoogle Scholar
  23. 23.
    Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36(1):8–27CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Khera R, Angraal S, Couch T, Welsh JW, Nallamothu BK, Girotra S, Chan PS, Krumholz HM (2017) Adherence to methodological standards in research using the national inpatient sample. JAMA 318(20):2011–2018. CrossRefPubMedGoogle Scholar
  25. 25.
    Issa M, Ananthakrishnan AN, Binion DG (2008) Clostridium difficile and inflammatory bowel disease. Inflamm Bowel Dis 14(10):1432–1442. CrossRefPubMedGoogle Scholar
  26. 26.
    Jalan KN, Sircus W, Card WI, Falconer CW, Bruce CB, Crean GP, McManus JP, Small WP, Smith AN (1969) An experience of ulcerative colitis. I. Toxic dilation in 55 cases. Gastroenterology 57(1):68–82PubMedGoogle Scholar
  27. 27.
    Gweon TG, Lee KJ, Kang DH, Park SS, Kim KH, Seong HJ, Ban TH, Moon SJ, Kim JS, Kim SW (2015) A case of toxic megacolon caused by clostridium difficile infection and treated with fecal microbiota transplantation. Gut Liver 9(2):247–250. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Trudel JL, Deschenes M, Mayrand S, Barkun AN (1995) Toxic megacolon complicating pseudomembranous enterocolitis. Dis Colon Rectum 38(10):1033–1038CrossRefPubMedGoogle Scholar
  29. 29.
    Sheth SG, LaMont JT (1998) Toxic megacolon. Lancet 351(9101):509–513. CrossRefPubMedGoogle Scholar
  30. 30.
    Sewell JL, Yee HF Jr (2012) 13-year mortality trends among hospitalized patients with inflammatory bowel disease. BMC Gastroenterol 12:79. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Shander A, Knight K, Thurer R, Adamson J, Spence R (2004) Prevalence and outcomes of anemia in surgery: a systematic review of the literature. Am J Med 116(Suppl 7A):58S–69S. CrossRefPubMedGoogle Scholar
  32. 32.
    Grottke O, Fries D, Nascimento B (2015) Perioperatively acquired disorders of coagulation. Curr Opin Anaesthesiol 28(2):113–122. CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Imbriaco M, Balthazar EJ (2001) Toxic megacolon: role of CT in evaluation and detection of complications. Clin Imaging 25(5):349–354CrossRefPubMedGoogle Scholar
  34. 34.
    D’Amico C, Vitale A, Angriman I, Ruffolo C, D’Amico F, Valente D, Berto M, Vella V, Scarpa M, D’Amico DF (2005) Early surgery for the treatment of toxic megacolon. Digestion 72(2–3):146–149. CrossRefPubMedGoogle Scholar
  35. 35.
    Toh JW, Stewart P, Rickard MJ, Leong R, Wang N, Young CJ (2016) Indications and surgical options for small bowel, large bowel and perianal Crohn’s disease. World J Gastroenterol WJG 22(40):8892–8904. CrossRefPubMedGoogle Scholar
  36. 36.
    Neal MD, Alverdy JC, Hall DE, Simmons RL, Zuckerbraun BS (2011) Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease. Ann Surg 254(3):423–427. [discussion 427-429] CrossRefPubMedGoogle Scholar
  37. 37.
    Tapani MJ, Olavi KH (2014) Surgical management of toxic megacolon. Hepatogastroenterology 61(131):638–641PubMedGoogle Scholar
  38. 38.
    Holder-Murray J, Marsicovetere P, Holubar SD (2015) Minimally invasive surgery for inflammatory bowel disease. Inflamm Bowel Dis 21(6):1443–1458. PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© SIMI 2018

Authors and Affiliations

  • Rajkumar Doshi
    • 1
    Email author
  • Jiten Desai
    • 2
  • Yash Shah
    • 3
  • Dean Decter
    • 4
  • Shreyans Doshi
    • 5
  1. 1.Department of Internal Medicine, Renown Regional Medical Center, School of MedicineUniversity of NevadaRenoUSA
  2. 2.Department of Internal MedicineNassau University Medical CenterEast MeadowUSA
  3. 3.Department of Internal Medicine, Icahn School of Medicine at Mount SinaiJames J. Peters VA Medical CenterBronxUSA
  4. 4.Department of CardiologyNorth Shore University Hospital, Northwell HealthManhassetUSA
  5. 5.Department of Internal Medicine, HCA GME Consortium’s Internal Medicine ProgramUniversity of Central Florida College of MedicineGainesvilleUSA

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