title: [Toxic megacolon].
abstract: BACKGROUND
  Toxic megacolon constitutes a feared, life-threatening complication of severe intestinal inflammation and is a challenge for interdisciplinary medical care.
  
  
  OBJECTIVE
  Specific aspects of conservative treatment based on current scientific evidence derived from guidelines, qualified reviews, and scientific studies are presented, which provide a rational approach and maximize therapeutic success.
  
  
  METHODS
  This work is based on a selective literature review and the authors' experience of many years in gastroenterology and intensive care.
  
  
  RESULTS
  Toxic megacolon requires a rapid interdisciplinary assessment. Depending on the underlying etiology, an individual treatment concept needs to be developed. If an infectious or inflammatory cause is probable, a conservative approach can reduce perioperative morbidity and mortality. A step-wise approach with controlled reevaluations of the response to therapy after 72 h and 7 days avoids uncontrolled delay of surgical options further ensuring patient safety.
  
  
  CONCLUSIONS
  Despite a decreasing incidence of toxic megacolon, it remains an interdisciplinary therapeutic challenge.
authors.affiliation: Medizinische Klinik 1, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Leppkes
authors.affiliation: Medizinische Klinik 1, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Ganslmayer
authors.affiliation: Medizinische Klinik 1, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Strauß
authors.affiliation: Medizinische Klinik 1, Universitätsklinik Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland. markus.neurath@uk-erlangen.de.
authors.forename: M F
authors.initials: MF
authors.lastname: Neurath
mesh_terms: D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003422:Critical Care; D016638:Critical Illness; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008532:Megacolon, Toxic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D011379:Prognosis
keywords: Clostridium difficile; Colitis, ulcerative; Cytomegalic inclusion disease; Intensive care; Pseudomembranous colitis