Images in Clinical Medicine
Chronic Ulcerative Colitis with Megacolon
N Engl J Med 2003; 349:358July 24, 2003
- Article
A 53-year-old woman with a history of ulcerative colitis presented with abdominal pain and bloody diarrhea. The abdominal examination revealed a distended and mildly tender abdomen with hypoactive bowel sounds. Plain films of the abdomen showed two characteristic features of ulcerative colitis — megacolon, with the transverse colon (normal diameter up to 6 cm) dilated to the height of 2.5 vertebrae (vertical arrows), and burned-out chronic colitis, with the left side of the colon showing foreshortening and a loss of haustra (arrowheads). The patient also had a Greenfield filter in place (horizontal arrow), since patients with inflammatory bowel disease are at increased risk for thromboembolic events but may not tolerate anticoagulation because of bleeding from the diseased colon. An attempt was made to treat the patient's fulminant colitis conservatively with antibiotics and corticosteroids, and later with cyclosporine. Since this management did not result in resolution of the clinical, endoscopic, and radiographic findings within seven days, a semi-urgent total abdominal colectomy with end ileostomy was performed. The patient was discharged home while receiving corticosteroids in gradually decreasing doses.
Andreas M. Kaiser, M.D.
Robert W. Beart, M.D.
University of Southern California, Los Angeles, CA 90033
