Kato, Masaki (M);Yamashita, Masaki (M);Tsukui, Mitsuto (M);Iijima, Yoshihiko (Y);Araki, Kenichi (K);Shikano, Naoki (N);Saji, Shiori (S);Tsukamoto, Kyoko (K);Ishida, Jun (J);Komatsu, Takumi (T);Nakamoto, Yusuke (Y);Kawashima, Akiyo (A);Endo, Akira (A);Matsunaga, Ayako (A);Sato, Yoshinori (Y);Maehata, Tadateru (T);Tateishi, Keisuke (K);

Author information

Case Rep Gastroenterol.2025 Oct 17;19(1):688-695.doi:10.1159/000547911

Abstract

INTRODUCTION: Toxic megacolon is a serious complication of ulcerative colitis (UC), characterized by marked colonic dilatation, abnormal bowel function, and systemic toxicity. Although toxic megacolon is rare in children and adolescents, it should remain in the differential diagnosis for acute severe UC in this group because delayed diagnosis and treatment can be fatal. The treatment for UC complicated by toxic megacolon is either immediate emergency surgery or short-term intensive drug therapy. If the latter does not result in significant improvement, emergency surgical intervention is necessary. Current treatment guidelines do not establish a standard medical approach for this condition.

CASE PRESENTATION: In this report, we describe an adolescent case of UC complicated by toxic megacolon. In this patient, the condition was initially controlled with steroid pulse therapy followed by oral tacrolimus. However, due to an inadequate response, treatment was escalated to infliximab (IFX), leading to remission and successful avoidance of surgical intervention.

CONCLUSION: When opting for conservative treatment of UC complicated by toxic megacolon, intensive steroid pulse, tacrolimus, and IFX therapy should be considered as a potentially effective treatment option.