Multiple Rectal Ulcers (34 of 110)

Second Hospitalization

After 10 days of ambulatory treatment and 18 after the
colonoscopy, the patient is readmitted to the hospital
because of increased abdominal pain and sepsis. WB
counts: 21,900 with 98% neutrophils, with a hemoglobin of
10 g/dl. The second day, patient presents with hypotension,
tachycardia and signs of tissue hypoperfusion those sign
are consistent of toxic megacolon.

The patient underwent emergency surgery
(Colectomy with ileostomy)

Cyanosis of the extremities

Clinically, the patient with toxic megacolon presents as
severely ill with a fever, tachycardia, dehydration,
abdominal pain and distention) Examination reveals
absent bowel sounds, tympany and rebound tenderness.
Leukocytosis (greater than 10,000), anemia and
hypoalbuminemia are often present. A plain x-ray of the
abdomen will reveal dilation of a colonic segment or of the
entire colon. On plain supine x-ray, dilation of the
transverse colon is most often seen. This distention of the
transverse colon does not indicate severity of disease in
this segment of the colon; rather, the distention is
determined by the anterior position of the transverse colon.
Repositioning the patient to a prone position will
redistribute the gas to the more posterior descending colon
and will dramatically decrease gaseous tension in the
transverse colon.