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Toxic megacolon — SCE Acute Medicine MCQ

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ModerateAcute Gastrointestinal PresentationsToxic megacolonSCE Acute Medicine

A 58-year-old man presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show systemic toxicity with transverse colon diameter 7 cm. What is the most appropriate next step in management?

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Correct answer: C — Seek urgent surgical and gastroenterology review with IV steroids and antibiotics

The key discriminator is that systemic toxicity with transverse colon diameter 7 cm, which makes Seek urgent surgical and gastroenterology review with IV steroids and antibiotics the single best answer. Arrange routine outpatient follow-up is less appropriate because it does not address the dominant acute risk in the vignette; Provide supportive care and close monitoring would fit a different presentation or later stage of care. Optimise chronic medication and discharge and Give analgesia and antiemetic therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSG IBD guideline