امرأة عمرها ٣١ سنة معروفة بالتهاب القولون التقرحي، عندها إسهال دموي ١٠ مرات يومياً من أسبوع. اليوم قلت مرات الإسهال فجأة، لكن البطن صار منتفخاً جداً ومؤلماً. الحرارة ٣٩٫١، النبض ١٢٨، الضغط ٩٦/٥٨. ما المضاعفة المتوقعة؟

A 31-year-old with ulcerative colitis has had bloody diarrhoea 10 times a day for a week. Today the diarrhoea suddenly decreased, but her abdomen is very distended and painful. T 39.1 °C, HR 128, BP 96/58. Which complication is likely?

1. Improvement of the colitis from treatment
2. Simple constipation after diarrhoea
3. Acute appendicitis
4. Toxic megacolon

Answer: D) Toxic megacolon. A sudden fall in stool frequency with severe distension, fever and tachycardia during a severe flare suggests toxic megacolon, which can perforate. Stop antimotility drugs and opioids and notify the provider immediately.