We present a rare case of
toxic megacolon accompanied by
necrosis of the colon due to chronic dilation caused by
stenosis of the sigmoid colon as a complication of
diverticulitis. The patient presented at the emergency department with diffuse
abdominal pain,
fever (38.8°C) and
tachycardia (120 beats/min). Physical examination revealed distension and tenderness on deep palpation on the left lower quadrant without peritoneal signs. Abdominal computed tomography showed located
stenosis in the sigmoid colon and marked dilation of the descending (12 cm diameter) and transverse (7.5 cm diameter) colon. A few hours later, the patient developed severe
septic shock with
electrolyte abnormalities. He had a history of two prior admissions to our hospital due to crises of acute
diverticulitis. Based on
Jalan's criteria the diagnosis was compatible with
toxic megacolon. The patient's condition deteriorated suddenly and an emergency
colectomy was performed. The operative findings revealed a necrotic colon. Histology examination confirmed the diagnosis of
ischemia of the colon. To our knowledge this is the first published report in the literature which refers to a rare complication of
diverticulitis, namely chronic
stenosis which complicated to colonic
ischemia and
toxic megacolon.