Which signs indicate possible toxic megacolon in a patient with colitis?

• A. Abdominal bloating and mild diarrhea.
• B. Severe dehydration and electrolyte disturbance.
• C. Severe abdominal distension, fever, tachycardia, leukocytosis, and radiographic colonic dilation.
• D. No signs of systemic illness.

Answer: (C)

Toxic megacolon shows up when the colon becomes severely dilated and the patient has systemic toxicity from the colitis. The best indicator is a combination of severe abdominal distension, fever, rapid heart rate, high white blood cell count, and clear radiographic evidence of colonic dilation. This reflects both the local collapse of motility with dilation and the body’s systemic inflammatory response, which together signal a dangerous complication that needs urgent attention. The other options don’t capture that combination: mild bloating with diarrhea isn’t specific to megacolon; dehydration and electrolyte disturbances can occur with colitis but aren’t the defining signs of megacolon; and having no systemic illness would make megacolon unlikely.