Toxic Megacolon due to Intestinal Pseudo-Obstruction

This is not the image you want to see after the patient had spent 4 weeks in the hospital.

The patient presented after a motor vehicle accident with a severe traumatic brain injury. The patient had a complicated hospital stay and ultimately required tracheostomy and a feeding tube placement.

On week 4 of her hospital stay she developed significant abdominal distention, tachycardia and fever.

The scout image of the abdominal CT is shown above (upper image). A significantly dilated colon was noted. Her cecum was distended to up to 13 cm. Considering her clinical signs and a significant colonic distention the patient was thought to have toxic megacolon due to intestinal pseudo-obstruction (Ogilvie syndrome). The infectious etiology including C-diff colitis was ruled out.

The patient was moved to the ICU once she became hypotensive.

The semi-upright chest XR (bottom image above) revealed the dreaded sign - free intraabdominal air (labeled FA).

The patient required colostomy with ileostomy placement.

An elderly patient was admitted as a trauma patient after a motor vehicle accident. He was started on opioid analgesics for pain control. Later in his hospital stay he started complaining on abdominal pain and distention. The patient became febrile. His white count was elevated. Abdominal XR showed a significant dilation of his right colon. The patient developed toxic megacolon.