Toxic megacolon: a rare presentation of complicated diverticular disease

Maria Alejandra Lastra Santiago; José Luis Ortiz Fernández; Daniel Herrera Hernández; Emilio Zevada Payan; Jimena Celeste Treviño Flores; Carlos Andrés Villamar Gutiérrez; Pablo Patricio Flores García; Angeles Yasunari Cortes Garcia; Alejandro Aguilar Sabori; Erick Antonio García Cruz

doi:10.18203/2349-2902.isj20251039

Authors

Maria Alejandra Lastra Santiago Servicio de Cirugía General, Centro Médico Nacional de Occidente, Guadalajara, Jalisco, México
José Luis Ortiz Fernández Hospital General de Gómez Palacio, Durango, México
Daniel Herrera Hernández Hospital General Regional No. 1, Instituto Mexicano del Seguro Social, Tijuana, Baja California, México
Emilio Zevada Payan Hospital General B ISSSTE, Ciudad Juárez, Chihuahua, México
Jimena Celeste Treviño Flores Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
Carlos Andrés Villamar Gutiérrez Hospital General Regional No. 1, Instituto Mexicano del Seguro Social, Tijuana, Baja California, México
Pablo Patricio Flores García Hospital Universitario José Eleuterio González, Monterrey, Nuevo León, México
Angeles Yasunari Cortes Garcia Hospital Regional ISSSTE, Morelia, Michoacán, México
Alejandro Aguilar Sabori Universidad Autónoma de Baja California, México
Erick Antonio García Cruz Universidad Regional del Sureste, Oaxaca, México

DOI:

https://doi.org/10.18203/2349-2902.isj20251039

Keywords:

Toxic megacolon, Diverticular disease, Subtotal colectomy

Abstract

Toxic megacolon is a life-threatening complication most commonly associated with inflammatory bowel disease (IBD) or Clostridioides difficile infection. Its occurrence secondary to complicated diverticular disease is exceedingly rare. We present the case of a 56-year-old woman who developed toxic megacolon in the context of sigmoid diverticular disease. She initially received intravenous antibiotics for Hinchey IB diverticulitis and was discharged on oral therapy. Four days later, she returned with abdominal distension, severe leukocytosis, and radiographic evidence of colonic dilatation and pneumatosis. Emergency surgery revealed a perforated stenotic sigmoid tumor with ischemic changes, and a subtotal colectomy was performed. Histopathological analysis confirmed ischemic colitis with features of toxic megacolon. The patient had an uneventful recovery and was discharged on postoperative day seven. Although toxic megacolon is classically linked to IBD and C. difficile, clinicians must be aware of rare etiologies such as complicated diverticular disease. Prompt recognition and early surgical intervention are crucial for favorable outcomes in atypical presentations.

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