Toxic colonoscopy—how investigating active inflammatory bowel disease can lead to the serious complication of toxic megacolon

Abstract

A 15-year-old girl presented to accident and emergency A&E unable to cope after a week-long history of abdominal pain with vomiting and blood-streaked diarrhoea. The patient had been known to the gastroenterologist for suspected inflammatory bowel disease and was due for an outpatient endoscopy. On examination, the patient was febrile and tachycardic. There were no mouth ulcers or skin changes, however, finger clubbing was present, there was guarding and the patient was tender in all quadrants. There were no palpable masses or evidence of organomegaly. Bowel sounds were present. The patient had been using a hot water bottle, which had caused erythema ab igne. The patient was expedited for oesophagogastroduodenoscopy and colonoscopy (figure 1) after having bowel preparation. Results displayed antral gastritis and severe colitis with …