COMPLICATED COLONIC CROHN'S DISEASE WITH INTRA-ABDOMINAL HYPERTENSION AND TOXIC MEGACOLON WITH SIGMOIDOSTOMY AS A COLON PRESERVATION STRATEGY: A CASE REPORT

Case Presentation A 40-year-old male patient, diagnosed with Crohn's Disease (CD) 6 years ago, Harvey Bradshaw Index (HBI - 8), was hospitalized due to hypersensitivity to the infusion of infliximab after the second dose of the induction phase, presenting with rash, tachycardia, and fever, requiring intensive care unit admission. Managed with antibiotic therapy and corticosteroids, the patient developed progressive abdominal distention due to toxic megacolon (TM) and was referred for surgical intervention due to compartment syndrome and failure of decompressing colonoscopy. The first approach involved exploratory laparotomy and Barker peritoneostomy. The patient was re-operated on three days later for abdominal wall closure and a loop sigmoidostomy. The first dose of adalimumab was administered five days after the procedure, with clinical improvement and disease control, continuing with outpatient follow-up and no further hospitalizations.

Discussion TM is the dilation of part or the entire colon (> 6 cm), accompanied by toxemia, manifesting as abdominal distension, pain, and signs of sepsis. It is one of the most feared complications of ulcerative colitis and can also occur in CD. It has high mortality rates, particularly when it culminates in compartment syndrome, and surgical treatment with partial or total colectomy is the treatment of choice. Colectomy is the resection of a segment or the entire colon, indicated in various pathologies but considered especially in emergencies, as a surgery with high morbidity and mortality. It can be associated with complications such as fistulas, bleeding, strictures, malabsorption syndromes, and increased hospitalization time. Loop sigmoidostomy involves opening a region of the sigmoid colon and exteriorizing it through the abdominal wall, decompressing the colon and preserving the segment, with the possibility of later assessing intestinal reconstruction. Following surgical intervention, clinical treatment with biologics should be associated to control the underlying disease.

Conclusion In this case, loop sigmoidostomy was chosen as the treatment for TM to decompress the segment without resecting it, as a strategy for intestinal preservation and lower morbidity and mortality. The prior creation of peritoneostomy to resolve compartment syndrome, combined with clinical treatment with adalimumab, contributed to the success of the treatment, with no decompensations or complications from CD or new hypersensitivity reactions.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025