In this episode, we tackle toxic megacolon, a life-threatening complication of severe colonic inflammation most commonly associated with ulcerative colitis and Clostridioides difficile infection. We review the pathophysiology of nitric oxide–mediated colonic paralysis, hallmark clinical features of systemic toxicity, and the critical imaging findings of colonic dilation ≥6 cm. The discussion emphasizes early recognition, ICU-level management, appropriate antimicrobial and corticosteroid therapy, and clear surgical indications.

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