In suspected toxic megacolon, what is the most feared complication if not treated promptly?

• A. Perforation with peritonitis
• B. Renal failure
• C. Myocardial infarction
• D. Pulmonary embolism

Answer: (A)

In suspected toxic megacolon, the gravest risk if treatment is delayed is perforation of the colon with resulting peritonitis. The colon becomes massively distended and inflamed; ongoing pressure and inflammation can erode the wall, leading to perforation. Once the bowel contents spill into the sterile peritoneal cavity, a rapid, life-threatening infection (sepsis) and widespread inflammation can ensue, and this carries a high mortality without urgent surgical management. That’s why prompt resuscitation, broad-spectrum antibiotics, electrolyte and fluid correction, and early surgical consultation are crucial. Other serious issues like renal failure, heart attack, or a pulmonary embolism can occur in hospitalized patients, but they are not the specific catastrophic event that toxic megacolon aims to prevent through swift intervention.