He had a fever of 101 degrees, decreased bowel sounds, and a tense, mildly distended abdomen. There are no abnormal collections of gas or fluid outside of the GI tract. Differential Diagnosis Findings are consistent with ulcerative colitis and suggest toxic megacolon. Diagnosis Toxic megacolon Discussion Toxic megacolon is defined as dilation of the colon with fulminant colitis. The diagnosis is based on the clinical findings and abnormalities found on plain film.
Barium enema is contraindicated in the case of toxic megacolon due to risk of perforation.
CT is useful for follow-up of treatment of toxic megacolon and diagnosis of complications. Toxic megacolon is one of the most important complications of ulcerative colitis. Plain film of the abdomen is the primary imaging modality for diagnosis of toxic megacolon. Urgent medical treatment is the next step. Close observation for consideration of surgical treatment if medical treatment fails is a must.