A 32-year-old male with ulcerative colitis presents with severe abdominal distension, fever (38.9°C), tachycardia (HR 125 bpm), and hypotension. Abdominal plain film reveals marked transverse colon dilatation measuring 7.5 cm in diameter. What is the diagnosis and initial management of toxic megacolon?

Answer and explanation

Correct answer: A. Toxic megacolon; IV fluid resuscitation, broad-spectrum antibiotics, and urgent surgical consultation

  1. Step 1: Colonic dilatation in the presence of systemic toxicity (fever, tachycardia, leukocytosis, altered sensorium) defines toxic megacolon.
  2. Step 2: Immediate management involves intensive ICU care: complete bowel rest, NG tube decompression, IV fluid resuscitation, broad-spectrum antibiotics, and high-dose IV corticosteroids, with immediate subtotal colectomy if perforation or failure to improve occurs.
Answer
Toxic megacolon; initiate aggressive IV fluid resuscitation, broad-spectrum antibiotics, IV steroids, and surgical consultation.
Why not the others: 'Colonoscopy' is strictly contraindicated due to extremely high risk of colonic perforation; 'Discharge home' is fatal in this medical-surgical emergency; 'Appendiceal abscess' does not cause massive colonic dilatation.

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