[Clinics and Practice 2013; 3:e24] [page 63] Toxic megacolon complicating afirst course of Crohn’s disease:about two cases

Toxic megacolon is a rare and serious com-plication of Crohn’s disease. Because of the associated high morbidity and mortality, early recognition and management of toxic mega-colon is important. Through two cases of toxic megacolon complicating Crohn’s disease, we assessed the clinical, radiologic and therapeu-tic characteristics of this complication. A 35-year-old man presented a first course of Crohn’s disease treated with corticosteroid. He exhibited sudden severe abdominal pain and distension with shock. A plain abdominal radi-ography revealed toxic megacolon. He under-went medical therapy, but symptoms not relieved. The patient underwent subtotal colec-tomy with ileostomy. The resected specimen confirmed the diagnosis. Recovery of digestive continuity was performed. Endoscopic evalua-tion six months later did not shown recur-rence. A 57-year-old man presented with severe acute colitis inaugurating Crohn’s dis-ease, was treated with corticosteroid and antibiotics. He exhibited signs of general peri-tonitis. Computed tomographic examination revealed toxic megacolon with free perfora-tion, showing prominent dilation of the trans-verse colon and linear pneumatosis. The patient underwent emergent subtotal colecto-my and ileostomy. The final histological pat-terns were consisting with diagnosis of Crohn’s disease associated with cytomegalovirus infection. The patient under-went antiviral therapy during 15 days. Because of the high risk of postoperative recurrence, he underwent immunosuppressive therapy. Recovery of digestive continuity was per-formed successfully. Toxic megacolon in Crohn’s disease is a serious turning of this dis-ease. We underscore the importance of early diagnosis of toxic megacolon and rapid surgi-cal intervention if improvement is not observed on medical therapy