A patient with ulcerative colitis develops fever, tachycardia, abdominal cramping, and an abdominal mass over the transverse colon. This presentation is most consistent with which complication?

• A. Tenesmus
• B. Toxic megacolon
• C. Carcinoma
• D. Rectal fistula

Answer: (B)

Recognizing toxic megacolon as a life-threatening complication of ulcerative colitis is the key idea here. The combination of fever, tachycardia, abdominal cramping, and a palpable mass over the transverse colon points to severe colonic dilation with systemic illness. In toxic megacolon, the inflamed colon loses smooth muscle tone and becomes markedly distended, which creates both the abdominal mass and the risk of complications like perforation, making urgent management essential.

Other possibilities don’t fit this acute, systemic picture as well. Tenesmus is a sense of incomplete evacuation from mucosal irritation, usually without a distended colon or systemic toxicity. Carcinoma tends to present more chronically with weight loss or occult bleeding rather than an acute toxic state and abdominal distension. Rectal fistula is more characteristic of Crohn disease and presents with drainage or irritation around the fistulous tract rather than a distended transverse colon with systemic signs.

So, the presentation best aligns with toxic megacolon, the severe complication of ulcerative colitis.