Toxic megacolon: The knee-elbow position relieves bowel distension

Toxic megacolon complicating inflammatory or infective colitis carries a high morbidity and mortality and surgical intervention is necessary in up to 80% of cases.¹² Perforation complicates toxic megacolon in about 35% of cases. After perforation, the death rate nears 50%.^3-5 Gaseous distension ofthe bowel causes considerable discomfort to the patient and increases transmural pressure. The latter is thought to cause a reduction in blood flow and may predispose to perforation.⁶ The use of instruments for colonic aspiration is discouraged, because of the high risk of perforation. 6 The successful use of the knee-elbow position to relieve bowel distension in two patients with toxic megacolon is described.