A 45-year-old patient with a history of ulcerative colitis presents to the emergency department with severe abdominal pain, fever, tachycardia, and significant abdominal distension. The attending physician is concerned about a potentially life-threatening complication and considers the indications for emergency surgery.
Which of the following is an indication for emergency surgery in a patient with colitis?
A. Poor compliance
B. Recurrent acute exacerbations
C. Growth retardation
D. Toxic megacolon
The correct answer is D. Toxic megacolon.
Explanation:
Toxic megacolon is a severe and potentially life-threatening complication of colitis (including ulcerative colitis and Crohn’s disease) that requires prompt recognition and intervention. Here’s why toxic megacolon is an indication for emergency surgery:
1. Toxic Megacolon (D):
– Toxic megacolon is characterized by severe inflammation leading to dilation of the colon, systemic toxicity, and risk of perforation.
– Clinical features include severe abdominal distension, fever, tachycardia, hypotension, altered mental status, and signs of systemic infection or sepsis.
– This condition requires immediate medical management, and if there is no rapid improvement, emergency surgery is necessary to prevent perforation and other complications.
2. Other Options:
– Poor Compliance (A): While poor compliance with medical therapy can lead to worsening disease and increased flare-ups, it is not an immediate indication for emergency surgery. Long-term management strategies need to be addressed.
– Recurrent Acute Exacerbations (B): Frequent flare-ups of colitis may necessitate changes in medical therapy or elective surgery, but they are not an indication for emergency surgery unless accompanied by complications like perforation or toxic megacolon.
– Growth Retardation (C): Growth retardation is a concern in pediatric patients with chronic colitis but is an indication for optimizing medical management or considering elective surgery rather than emergency surgery.Toxic megacolon represents an acute, severe complication of colitis that requires immediate surgical intervention if not responsive to medical treatment, making D. Toxic megacolon the correct answer.