Toxic megacolon is a serious complication that can occur if inflammation spreads into the deeper layers of the colon. In such cases, the colon enlarges and becomes paralyzed. In severe cases, it may rupture, a surgical emergency that carries a 30% mortality rate. Symptoms include weakness and abdominal pain and bloating; the patient may be disoriented or groggy. X-rays are needed to confirm the diagnosis, but barium enemas and colonoscopies should not be performed. Toxic megacolon is more likely to occur with ulcerative colitis, but it can also develop in Crohn's disease. Unfortunately, medications used for pain and diarrhea, such as opiates, and drugs that reduce spasms of the colon may increase the risk of toxic megacolon, although its incidence is decreasing as more effective treatments are developed.
Fistulas
The deep ulcers of Crohn's disease frequently result in the development of fistulas, channels that can burrow between organs, loops of the intestine, or between the intestines and skin. If fistulas develop between the loops of the small and large intestines, they can interfere with absorption of nutrients. They often form pockets of infection or abscesses, which may become life threatening without treatment. Fistulas are rare in ulcerative colitis.
Intestinal Blockage
Inflammation from Crohn's disease produces segments of scar tissue known as strictures that can constrict the passages of the intestines, causing bowel obstruction with severe cramps and vomiting. Strictures usually occur in the small intestine but can also occur in the large intestine.
Cancer
Chronic ulcerative colitis increases the risk for colon cancer. In different studies, this risk has been estimated to be 5% to 10% after 10 years and 15% to 40% after 30 years. People with ulcerative colitis should consider annual screening with colonoscopy beginning as early as age 25, depending on other risk factors, particularly any evidence of precancerous tissue (dysplasia). Individuals should discuss with their physician the risks and benefits of these screening procedures. Inflammatory bowel disease in the rectum and lower (sigmoid) colon does not significantly increase the risk for cancer.
Patients with Crohn's disease of the colon have a similar risk for colon cancers. Other cancers, such as lymphoma or carcinoma of the small intestine or anus, may also be more common in patients with Crohn's disease, but the risk is not high.
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