A 34-year-old woman with acute severe ulcerative colitis develops abdominal distension and tenderness. Plain abdominal radiograph shows a transverse colon diameter of 7.5 cm with loss of haustra. She is febrile with a pulse of 118/min. Which intervention is contraindicated?
- A Full colonoscopy with bowel preparation to assess mucosal severity ✓
- B Nasogastric decompression with nil per os status
- C Intravenous corticosteroids and broad-spectrum antibiotics
- D Urgent surgical consultation for possible subtotal colectomy
Explanation
This is toxic megacolon, defined as colonic dilatation exceeding 6 cm with systemic toxicity in severe colitis. Full colonoscopy with insufflation risks perforation and is contraindicated; even unprepped limited sigmoidoscopy is performed cautiously only if needed. Management includes intravenous steroids, broad-spectrum antibiotics, nasogastric decompression, correction of electrolytes, serial radiographs, and surgical consultation, since lack of improvement within 24 to 72 hours mandates subtotal colectomy. Bowel preparation further distends the colon and increases perforation risk.
Reference: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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