A 22-year-old man with known ulcerative colitis presents with bloody diarrhea 12 times/day, fever 38.8°C, heart rate 110 bpm, hemoglobin 9.8 g/dL, and ESR 65 mm/hr. Abdominal X-ray shows a transverse colon diameter of 7 cm. According to the Oxford criteria, how many of these features predict the need for colectomy on day 3 of admission?
- A Stool frequency >8/day and CRP >45 mg/L
- B Stool frequency >8/day and CRP >45 mg/L on day 3 ✓
- C Tachycardia >90 bpm and fever >37.8°C
- D Tachycardia >90 bpm, fever >37.8°C, and stool frequency >8/day
Correct answer: B. Stool frequency >8/day and CRP >45 mg/L on day 3
Explanation
The Oxford criteria for predicting colectomy in acute severe UC use day 3 stool frequency >8/day and CRP >45 mg/L. The original Travis criteria identified these two variables as independent predictors of failure of intravenous corticosteroid therapy. Fever and tachycardia are supportive features but not the specific Oxford criteria. The colon diameter of 6 cm or more indicates toxic megacolon, a separate emergency indication.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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