Extension of the mucosal inflammation may also be important. In contrast to typical ulcerative colitis in which the inflammatory response is limited to the mucosa, toxic megacolon is characterized by severe inflammation of the smooth muscle layer which paralyzes the colonic smooth muscle, thereby leading to dilatation. The extent of dilatation appears to be correlated with the depth of inflammation and ulceration. Damage to the myenteric plexus of the colon is not a consistent finding.
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