A Silent Threat: Toxic Megacolon Masquerading as Constipation in the Postpartum Period

AUTHOURS: WATTHUHEWA DAMAYANTHA , HIRSI-FARAH SUAD , SINGARATHNAM KANDASAMY

 

GEORGE ELIOT HOSPITAL NHS TRUST , O&G, NUNEATON, UNITED KINGDOM . EP.1150

BACKGROUND

Toxic megacolon is a rare but life-threatening complication of

Clostridium difficile infection (CDI). In the postpartum period, its

diagnosis can be easily missed due to overlapping symptoms with

common obstetric complaints, such as constipation and uterine

involution.

CASE SUMMARY

Case Summary

Patient: 29-year-old, recent preterm delivery at 34 weeks

due to suspected chorioamnionitis.

Postpartum Day 2: Readmitted with malaise, abdominal

pain, and constipation. Initial assessment was unremarkable;

managed conservatively for presumed constipation.

Rapid Deterioration: Within 24 hours, developed

tachycardia, pyrexia, and significant abdominal distension.

Re-evaluation: Raised suspicion for toxic megacolon →

urgent imaging → emergency laparotomy.

Findings: Grossly dilated colon, bowel necrosis, and

perforation due to fulminant CDI.

Management: Subtotal colectomy with defunctioning colostomy.

Outcome: ICU admission → full recovery → stoma reversal at 6 months.

DICUSSION

Initial misdiagnosis stemmed from overlap with benign postpartum gastrointestinal symptoms.

The recent use of broad-spectrum antibiotics (for chorioamnionitis) likely triggered the CDI.

Delay in recognising signs of systemic toxicity contributed to advanced disease requiring

major surgical intervention.

LEARNING POINTS

CDI should be considered in postpartum women with abdominal symptoms and recent antibiotic

use.

Do not dismiss

‘

’

constipation

with systemic deterioration.

Early surgical input and cross-specialty collaboration are essential for optimal outcomes.

Prompt diagnosis may prevent bowel necrosis, perforation, and prolonged morbidity.

CONCLUSION

This case underlines the importance of maintaining a high index of suspicion for CDI and toxic

megacolon in postpartum women with abdominal symptoms, especially those exposed to

antibiotics. Timely diagnosis and multidisciplinary action are critical to reduce maternal

morbidity and mortality.

REFERENCES

1.Lessa FC et al. N Engl J Med. 2015;372(9):825–34.

2.Surawicz CM et al. Am J Gastroenterol. 2013;108(4):478–98.

3.Kothadia JP et al. BMJ Case Rep. 2013;2013:bcr2013200725.

4.RCOG Green-top Guideline No. 64a: Bacterial sepsis in pregnancy (2012).