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Toxic megacolon — SCE Acute Medicine MCQ

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ModerateAcute GI PresentationsToxic megacolonSCE Acute Medicine

A 36-year-old man is assessed on the acute medical unit. He has severe colitis with fever, tachycardia and abdominal distension. Abdominal radiograph shows transverse colon diameter 7 cm. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: B — Toxic megacolon

Toxic megacolon is the best answer because systemic toxicity plus colonic dilatation in colitis indicates toxic megacolon. Acute diverticulitis with abscess is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Antimotility drugs and opioids can worsen toxic megacolon.

Reference: https://www.bsg.org.uk/clinical-resource/#acute-medicine-order-63-1