A 25-year-old man with a severe flare of ulcerative colitis has abdominal distension, fever of 38.9 degrees Celsius, tachycardia, and a plain film showing a transverse colon diameter of 7.5 cm. He is started on intravenous fluids, broad-spectrum antibiotics, and intravenous hydrocortisone. Which additional measure is mandatory in his initial management?
- A Serial abdominal radiographs with surgical involvement and daily reassessment ✓
- B Urgent full colonoscopy with biopsies to confirm disease extent
- C Immediate subtotal colectomy with end ileostomy
- D Oral loperamide to reduce diarrhoeal losses
Correct answer: A. Serial abdominal radiographs with surgical involvement and daily reassessment
Explanation
Toxic megacolon requires monitoring of colonic diameter with serial radiographs alongside joint medical and surgical care; deterioration or failure to improve within 48 to 72 hours mandates subtotal colectomy with ileostomy. Full colonoscopy risks perforating the dilated friable bowel and is contraindicated. Loperamide and other antimotility agents are avoided because they precipitate toxic dilatation. Immediate surgery is reserved for free perforation, uncontrolled haemorrhage, or refractory sepsis.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.