Ulcerative colitis - toxic megacolon
This 47-year-old male complained of three weeks of diarrhea with admixture of blood and mucus. There was no prior history of a bowel disorder. Pronounced bloating of the abdomen, lack of appetite and worsening of his general health led to inpatient admission. Laboratory testing revealed significant elevations in C-reactive protein (CRP), leukocyte count and creatinine. Stool cultures were negative for pathogenic bacteria or viruses. In light of the patient’s very serious condition, an indication for decompression of the colon was established. The extremely distended transverse colon was successfully decompressed using a tube. After about one week and improvement in the patient’s general condition, patient was transferred for surgical treatment.
he video clip begins in the rectum. The endoscope is advanced through the highly inflamed colon as far as the splenic flexure. The bowel is filled with pus and liquid stool. Following passage of a stenosis near the splenic flexure, the proximal colon is significantly dilated. During the entire examination, no peristalsis is observed. A leader wire is next placed deep into the transverse colon and the endoscope is withdrawn. Following withdrawal of the endoscope, an 18-french decompression tube is placed by means of the leader wire.
Histology confirmed severe diffuse chronic colitis with crypt abscesses. These findings are most consistent with ulcerative colitis. Patient’s history is quite short in light of these chronic changes. Both clinical and endoscopic findings underscored the risk of impending development of toxic megacolon. Decision-making with respect to conservative vs. surgical management should occur in an interdisciplinary context in close cooperation with the surgeon. Colonoscopy with placement of a decompression tube should be entrusted to an experienced endoscopist.