[Toxic megacolon presenting as Crohn's disease]

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.