Acute toxic megacolon in visceral myopathy: A rare and challenging case report with literature review

Toxic megacolon is an unusual but life-threatening condition characterized by acute dilation of the colon associated with systemic manifestations. Visceral myopathy is a rare primary motility disorder affecting smooth muscles, including the gastrointestinal system. Although it is seldom reported in the literature, toxic megacolon can present in a patient with visceral myopathy, complicating the diagnosis and management process. Following CARE guidelines, we report a 25-year-old female patient who presented with 2 two-day duration of obstipation. Diagnostic work-up including, full labs, abdominal x-rays, and computed tomography scan revealed acute toxic megacolon. Despite initial medical management, the patient's condition deteriorated necessitating the need for surgical intervention. Postoperative histopathological examination revealed an underlying diagnosis of visceral myopathy. The patient underwent subtotal colectomy with ileorectal anastomosis and protective loop ileostomy. A multidisciplinary approach, including the involvement of gastroenterology and rheumatology teams, was crucial for optimal care and follow-up. This case highlights the critical approach to patients with visceral myopathy presenting with acute toxic mega colon. Future research should focus on this rare but important association, to improve early recognition, diagnosis, and treatment of such complex cases.