[Toxic megacolon presenting as Crohn's disease]

We introduce a young patient, without history of inflammatory bowel disease (I.B.D.) who started with an acute gastroenteritis, which in the following days progressed to a toxic megacolon. The patient had come to hospital with nausea, vomiting, fever and liquid, explosive diarrhoea without pathologic products. There was no clinical remission with astringent diet, hydroelectrolitic reposition and antidiarrheic opiates. The patient was admitted in hospital when he had blood in the diarrhoea. This progressed to a toxic megacolon in three days and the patient had to be operated on urgently. The surgeons found perforations in the colon and the pathologists diagnosed Crohn disease. Even without previous E.B.D. history we reached the diagnosis from the clinical and analytical data and the plain abdominal radiology. It was impossible to confirm the diagnosis with a colonoscopy because of the high risk of perforation. In cases like this, early surgery may save the life of the patient.