Toxic megacolon: A rare presentation and novel treatment

A 14-year-old male presented with toxic megacolon (TM). Stool culture and rectal biopsies ruled out Clostridium difficile infection and Hirschsprung disease, respectively. Anorectal manometry ruled out anal achalasia as rectoanal inhibitory reflex elicited a normal resting pressure. Colonic motility study showed distal colonic dysmotility and was consistent with a history of chronic constipation and encopresis. He initially underwent a diverting loop ileostomy, which ultimately improved his clinical status and resolved his TM without total abdominal colectomy. Diverting loop ileostomy and antegrade colonic enemas for TM should be considered as an alternative to the standard total abdominal colectomy and end ileostomy in the pediatric population.