Case Report: Toxic megacolon secondary to chronic constipation and cocaine consumption

Abstract

Toxic megacolon (TM) is a severe condition characterized by acute colonic dilation, with specific radiological and clinical signs. The multifactorial etiology of TM is primarily associated with inflammatory bowel disease and infections. However, TM remains a challenging complication due to its potential for rapid progression to life-threatening conditions. This report describes a rare case of TM in a 25-year-old male with a history of recurrent constipation and chronic cocaine consumption. Examination and imaging indicated acute intestinal obstruction with dilated colon segments and fecal impaction, necessitating an urgent laparotomy. Surgery revealed pan-colonic dilatation and sigmoid perforations, leading to a total colectomy and ileostomy. Chronic constipation, often perceived as benign, can escalate into a critical situation, possibly exacerbated by cocaine-induced muscle weakness and hypoxia. Evidence suggests that cocaine negatively affects the intestinal mucosa, potentially leading to ischemia. Chronic factors, including the use of enemas, may have contributed to megacolon development and perforation. Overall, this report underscores the critical elements of diagnosis and the importance of patients' medical history, particularly those with unusual risk profiles. In addition, it highlights the need for further research to fully understand the implications of these cases.

Keywords: bowel perforation; chronic constipation; cocaine abuse; total colectomy; toxic megacolon.

Figure 1

(A) Anteroposterior chest radiograph demonstrating significant colonic dilation. The radiograph reveals extensive gaseous distension of the colon, characteristic of toxic megacolon. The diaphragm is elevated, and there is notable colonic distension. (B) The image highlights the extent of colonic dilation with air-fluid levels indicative of an obstructive process. The patient exhibits marked gaseous distension of the intestines, consistent with the diagnosis of toxic megacolon.

Figure 2

(A) Coronal CT scan displaying significant colonic dilation with extensive gaseous distension. (B) Sagittal CT scan showing severe abdominal distension and colonic dilation.

Figure 3

(A) Intraoperative view showing the initial incision and exposure of the markedly distended colon. The image demonstrates the surgical approach taken to access the affected bowel. (B) Intraoperative image depicting the resected colon during total colectomy. The surgical team is shown handling the excised specimen, which displays severe distension and pathological changes characteristic of toxic megacolon.

Figure 4

The resected specimen colon is markedly dilated, with extensive areas of congestion, hemorrhage, and ulceration visible on the mucosal surface. The segment exhibits both pan-colonic dilation and structural compromise.