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[Toxic megacolon presenting as Crohn's disease]
S Sánchez Yubero1, A López Gil, J A Pérez Rojo
1Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid.
Anales De Medicina Interna (Madrid, Spain : 1984)
|January 19, 2000
Summary
A young patient developed toxic megacolon and colon perforation after acute gastroenteritis, leading to an urgent surgery. Crohn disease was diagnosed postoperatively, highlighting the importance of early surgical intervention in severe inflammatory bowel disease cases.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Pathology
Background:
- Inflammatory bowel disease (IBD) can present acutely without prior history.
- Toxic megacolon is a severe complication of IBD, often requiring surgical intervention.
- Early diagnosis and management are crucial for favorable outcomes in IBD.
Observation:
- A young patient presented with acute gastroenteritis symptoms including nausea, vomiting, fever, and explosive diarrhea.
- Despite initial conservative management, the patient's condition rapidly deteriorated, progressing to toxic megacolon with bloody diarrhea within three days.
- Clinical presentation, laboratory data, and plain abdominal radiology suggested a diagnosis, but colonoscopy was contraindicated due to perforation risk.
Findings:
- Surgical exploration revealed colon perforations.
- Histopathological examination diagnosed Crohn disease as the underlying cause.
- The patient's presentation mimicked acute gastroenteritis initially, masking the underlying Crohn disease.
Implications:
- This case underscores the potential for Crohn disease to manifest initially as acute gastroenteritis, progressing rapidly to a life-threatening toxic megacolon.
- Early surgical intervention is critical in managing acute IBD complications like toxic megacolon with perforation.
- Diagnostic challenges in IBD require a high index of suspicion, even in the absence of a prior history.