A 28-year-old man admitted with severe ulcerative colitis develops fever, tachycardia, abdominal distension and tenderness. Abdominal radiograph shows a transverse colon diameter of 7 cm with no free air. Which intervention must be avoided in his initial management?

• A Intravenous hydrocortisone and broad spectrum antibiotics
• B Subtotal colectomy with ileostomy if he deteriorates
• C Serial abdominal radiographs and surgical review
• D Full diagnostic colonoscopy with insufflation ✓

Explanation

This patient has toxic megacolon: systemic toxicity with colonic dilatation exceeding 6 cm, usually of the transverse colon. Full colonoscopy with air insufflation is contraindicated because distension and mechanical trauma risk perforating the friable inflamed bowel; even flexible sigmoidoscopy is performed minimally, if at all, without preparation. Management includes resuscitation, intravenous corticosteroids, antibiotics, serial imaging, and rescue subtotal colectomy with end ileostomy for perforation, uncontrolled sepsis, or lack of improvement.

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.