Toxic dilatation of colon in Crohn's disease

12 cases of toxic dilatation of the colon in Crohn's disease were reviewed. In 11 this complication seemed to be the first manifestation of the disease and a considerable diagnostic delay may partly account for the strikingly high mortality (50%). On admission 83% had clinical features suggestive of Crohn's disease and 58% had experienced symptoms suggestive of preceding gastrointestinal disease. An iatrogenic precipitating factor was identifiable in all but the 1 patient with established disease and in 83% of cases antidiarrhoeals had been prescribed. Preoperative perforation occurred in 4 patients, 3 of whom had had a barium-enema examination, and thromboembolism was a common postoperative complication (50%). Fever, tachycardia, low serum calcium, and low serum albumin in a patient with diarrhoea, abdominal pain, and distension should alert the physician to the possibility of Crohn's disease even in the absence of preexisting symptoms. Sigmoidoscopy should be an early investigation with particular attention being paid to perianal disease.