A 25-year-old man with a severe flare of ulcerative colitis develops abdominal distension, fever of 39 degrees Celsius, tachycardia of 128 per minute, and a transverse colon diameter of 7 cm on plain radiograph. He is started on intravenous steroids, fluids, and broad-spectrum antibiotics. After 48 hours there is no improvement and he develops rebound tenderness. What is the next step?

• A Add intravenous ciclosporin and continue medical therapy
• B Perform urgent total abdominal colectomy with end ileostomy ✓
• C Proceed to full colonoscopy with biopsy to assess mucosal viability
• D Administer infliximab infusion and reassess at 72 hours

Explanation

Toxic megacolon complicating ulcerative colitis is defined by systemic toxicity with colonic dilatation exceeding 6 cm. Failure of 24 to 72 hours of intensive medical therapy mandates surgery, and the development of peritonism indicates impending or actual perforation, which is an absolute indication for emergency operation. Subtotal colectomy with end ileostomy and rectal stump preservation is standard, leaving ileal pouch reconstruction for later. Full colonoscopy risks perforation and is contraindicated.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.