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From questions on page 188
Figure 1 shows large bowel dilatation. Figure 2 demonstrates worsening colonic dilatation, despite aggressive medical management, consistent with toxic megacolon extending proximally to the caecum. In keeping with an acute flare of inflammatory bowel disease mucosal thickening and loss of haustral folds is also present.
Toxic megacolon is a catastrophic complication of ulcerative colitis requiring surgical intervention. This patient subsequently underwent a subtotal colectomy with formation of an ileostomy.
Inflammatory bowel disease has a more severe phenotype in children.1 Persistent colonic dilatation (≥56 mm) strongly predicts future toxic megacolon and is associated with a higher rate of corticosteroid failure.2 ,3 The absence of gaseous distension is associated with a more favourable outcome to medical management.4
The abdominal X-radiograph is an invaluable investigation that aids in the diagnosis and assessment of disease and in predicting patients’ clinical course and the possible efficacy, or otherwise, of aggressive medical management.
Contributors The report was written by KDJ. MRG and MDB were clinical supervisors.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.
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