Toxic Megacolon


Step 1: View clinicals

A 20-year-old woman presents with a one-week history of blood and mucus diarrhea and generalized cramping abdominal pain. She has felt weak since waking up today. There is no history of fever. She was diagnosed with ulcerative colitis five years ago, for which she is currently on maintenance therapy with oral mesalazine 2.5 g QD. She has no other co-morbidities. She is not on any other medications, including over-the-counter supplements. Her surgical history is unremarkable. She does not smoke or drink and is currently on a normal diet.

Step 2: Order all relevant investigations

Complete blood count + serum electrolytes

WBC: 8,400/mm3 (4,600-11,000) Hb: 10.8 g/dL (11-16) Hct: 34% (35-45) Plt: 440,000/mm3 (150,000-450,000) Na+: 150 mEq/L (135-145) Cl-: 110 mEq/L (95-105) K+: 3 mEq/L (3.5-5)

X-ray abdomen

The transverse colon is dilated to 9 cm in diameter, with a loss of haustral markings.

Stool microscopy and cultures

Stool microscopy is negative for amoebae, ova, or cysts. Culture results will be available in 48 to 72 hours.


You realize that a colonoscopy is not a good idea right now.

Step 3: Select appropriate management

IV Fluids
Early surgery

Score: ★★☆