Toxic Megacolon Complicating a First Course of Crohn’s Disease: About Two Cases
A 35-year-old man with history of diabetes, presented with bloody diarrhea. Colonoscopy has demonstrated typical findings of Crohn’s colitis with severe inflammation. He underwent glucocorticoid therapy, and on the 20th day of treatment, he exhibited sudden severe abdominal pain and distension. On physical examination, the patient had tachycardia of 125 beats per min, fever to 38.3°C, hypotension, and his abdomen was diffusely tender. A plain abdominal radiography revealed TM, showing prominent dilatation of the transverse colon (). Computed tomographic (CT) examination excluded perforation. Intravenous corticosteroids and broad-spectrum antibiotics during 72 h not relieved symptoms. The patient underwent subtotal colectomy with ileostomy. The resected specimen confirmed diagnosis of CD. The postoperative course was uneventful. Recovery of digestive continuity was performed. Endoscopic evaluation six months later did not shown recurrence (Rutgeerts score i-0). There was no indication to postoperative medical therapy to maintain remission. The evolution was uneventful at 2 years follow-up.