Megacolon is considered present if the diameter of the colon is 5.5 cm or more, with apparent edema of the bowel wall on plain abdominal radiographs. Rarely, the toxic dilatation may extend to the terminal ileum. Colonic dilatation may be superimposed on an acute fulminant colitis in a patient with a history of inflammatory bowel disease. The dilatation may fluctuate or resolve completely, leaving the patient with toxic colitis. Clostridium difficile is the most common causative agent implicated in pseudomembranous colitis.
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