Toxic Megacolon Complicating a First Course of Crohn’s Disease: About Two Cases
A 57-year-old man, with no past medical history, presented with bloody diarrhea and fever to 39°C. Colonoscopy showed findings of severe acute colitis. Biopsy specimen revealed severe Crohn’s colitis. The patient underwent intravenous corticosteroid therapy and antibiotics. Seven days later, he presented abdominal pain and distension. On physical examination, the patient had pulse rate of 123 beats per min, hypotension, abdominal distension and tenderness with signs of general peritonitis. Laboratory findings revealed hyperleucocytosis (18,200/mm3), C-reactive protein 296 mg/L. A plain abdominal radiography showed dilatation of the transverse colon and linear pneumatosis. CT examination revealed TM with free perforation, showing prominent dilation of the transverse colon and linear pneumatosis pararelling the bowel wall (). The patient underwent emergent subtotal colectomy and ileostomy. The final histological patterns were consisting with the diagnosis of CD associated with the presence of cytomegalovirus (CMV) inclusions. The patient underwent antiviral therapy (ganciclovir 10 mg/kg/day) during 15 days. Because of the high risk of postoperative recurrence, the patient underwent immunosuppressive therapy (azathioprine 2.5 mg/kg/day). Recovery of digestive continuity was performed with no recurrence at 8 months follow-up.