Toxic megacolon complicating a first course of Crohn’s disease: about two cases

  • Rania Hefaiedh | rania.hefaiedh@hotmail.com Department of Gastroenterology, Mongi Slim University Hospital, La Marsa, Tunisia.
  • Mariem Cheikh Department of Gastroenterology, Mongi Slim University Hospital, La Marsa, Tunisia.
  • Rym Ennaifer Department of Gastroenterology, Mongi Slim University Hospital, La Marsa, Tunisia.
  • Lassad Gharbi Department of Surgery, Mongi Slim University Hospital, La Marsa, Tunisia.
  • Najet Bel Hadj Department of Gastroenterology, Mongi Slim University Hospital, La Marsa, Tunisia.

Abstract

Toxic megacolon is a rare and serious complication of Crohn’s disease. Because of the associated high morbidity and mortality, early recognition and management of toxic megacolon is important. Through two cases of toxic megacolon complicating Crohn’s disease, we assessed the clinical, radiologic and therapeutic characteristics of this complication. A 35-year-old man presented a first course of Crohn’s disease treated with corticosteroid. He exhibited sudden severe abdominal pain and distension with shock. A plain abdominal radiography revealed toxic megacolon. He underwent medical therapy, but symptoms not relieved. The patient underwent subtotal colectomy with ileostomy. The resected specimen confirmed the diagnosis. Recovery of digestive continuity was performed. Endoscopic evaluation six months later did not shown recurrence. A 57-year-old man presented with severe acute colitis inaugurating Crohn’s disease, was treated with corticosteroid and antibiotics. He exhibited signs of general peritonitis. Computed tomographic examination revealed toxic megacolon with free perforation, showing prominent dilation of the transverse colon and linear pneumatosis. The patient underwent emergent subtotal colectomy and ileostomy. The final histological patterns were consisting with diagnosis of Crohn’s disease associated with cytomegalovirus infection. The patient underwent antiviral therapy during 15 days. Because of the high risk of postoperative recurrence, he underwent immunosuppressive therapy. Recovery of digestive continuity was performed successfully. Toxic megacolon in Crohn’s disease is a serious turning of this disease. We underscore the importance of early diagnosis of toxic megacolon and rapid surgical intervention if improvement is not observed on medical therapy.

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Published
2013-09-09
Section
Case Reports
Keywords:
Crohn’s disease, acute severe colitis, toxic megacolon, corticosteroids, surgery.
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How to Cite
Hefaiedh, R., Cheikh, M., Ennaifer, R., Gharbi, L., & Bel Hadj, N. (2013). Toxic megacolon complicating a first course of Crohn’s disease: about two cases. Clinics and Practice, 3(2), e24. https://doi.org/10.4081/cp.2013.e24