Toxic megacolon: The Daily PANCE Blueprint

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Toxic megacolon: The Daily PANCE Blueprint

A 34-year-old woman with a history of ulcerative colitis presents to the emergency department with severe abdominal pain, distention, and bloody diarrhea. She appears ill and is tachycardic, hypotensive, and febrile. Abdominal examination reveals a significantly distended, tender abdomen with absent bowel sounds. Laboratory tests indicate leukocytosis and elevated inflammatory markers. An abdominal X-ray shows colonic dilation. Which of the following is the most appropriate next step in management?

A. Barium enema
B. Colonoscopy
C. Intravenous corticosteroids and antibiotics
D. Oral sulfasalazine
E. Flexible sigmoidoscopy

Answer and topic summary

The answer is ANSWERHERE

The patient’s presentation is consistent with toxic megacolon, a severe complication of inflammatory bowel disease (IBD). The combination of systemic toxicity, significant colonic dilation, and a history of IBD supports this diagnosis. Immediate treatment involves supportive care, broad-spectrum antibiotics to cover gut flora, and intravenous corticosteroids to suppress inflammation. Monitoring in the intensive care unit and surgical consultation are warranted.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒Colorectal disorders (PEARLS) ⇒ Toxic megacolon

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