TOO MUCH COLON FOR TOO LITTLE SPACE: TOXIC MEGACOLON IN A YOUNG ADULT WITH CHRONIC CONSTIPATION horaciosousa98@gmail.com

PE089

TOO MUCH COLON FOR TOO LITTLE SPACE: TOXIC MEGACOLON IN A YOUNG ADULT WITH CHRONIC CONSTIPATION

8

Portugal

Poster Exhibition only

Toxic megacolon is a rare emergency, defined by acute colonic dilatation associated with systemic toxicity, usually in the context of severe inflammatory colitis. However, it can also occur in patients with chronic functional constipation.

We describe the case of a 28-year-old man with a history of severe constipation and primary encopresis, admitted with severe abdominal pain and marked distension for 12 hours. On admission, he presented signs of shock, peritonitis, and a large, immobile fecaloma on digital rectal examination. After initial stabilization, an exploratory laparotomy revealed massive colonic dilatation with ischemia of the transverse colon and cecum, as well as a hard fecaloma in the sigmoid colon. A total colectomy with terminal ileostomy and rectal stump lavage was performed. The postoperative course began in the intensive care unit, with an initially favorable recovery. On the third postoperative day, the patient developed new hypotension, with imaging showing pneumoperitoneum. He underwent reoperation, with no evidence of anastomotic leak.

Histopathological examination revealed transmural mucosal ulceration, extensive ischemic changes, marked submucosal fibrosis, and muscular layer thickening, with no signs of malignancy or inflammatory bowel disease, consistent with chronic functional megacolon complicated by acute ischemia.

This case illustrates that toxic megacolon may arise outside the classic inflammatory context, requiring a high index of suspicion in patients with marked distension and systemic signs. Early total colectomy can be lifesaving, and multidisciplinary follow-up is essential for intestinal rehabilitation and recurrence prevention.