A 29-year-old male with inflammatory bowel disease presents with severe bloody diarrhea (10 stools/day), tachycardia (110 bpm), fever, and marked abdominal distension. Plain abdominal radiograph shows transverse colon dilation of 7.2 cm. What is the life-threatening complication?

Answer and explanation

Correct answer: C. Toxic megacolon

  1. Step 1: Toxic megacolon is a catastrophic complication of severe ulcerative colitis or infectious colitis (e.g., C. difficile).
  2. Step 2: Diagnostic criteria include systemic toxicity (fever, tachycardia, leukocytosis) plus radiological evidence of non-obstructive colonic dilation > 6 cm (frequently involving the transverse colon).
  3. Step 3: Management involves bowel rest, IV corticosteroids, broad-spectrum antibiotics, and surgical consultation for colectomy.
Answer
Toxic megacolon.
Why not the others: 'Intussusception' is uncommon in adults and presents with target signs on CT; 'Small bowel volvulus' dilates small intestinal loops without colonic prominence; 'Sigmoid diverticulitis' produces focal left lower quadrant phlegmon and wall thickening without massive transverse colonic dilation.

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