Finding-the-Path: Plain radiographs of the abdomen

Supine and upright plain radiographs of the abdomen show moderate dilation of the colon with loss of haustration in the descending colon (arrows). There are polypoid filling defects in the sigmoid and descending colon (arrow). Thickening of the wall of the colon indicates edema (arrow). There are no abnormal collections of gas or fluid outside of the GI tract. Findings are consistent with ulcerative colitis and suggest toxic megacolon.

What is the next step for this disorder?

• Barium enema
• Ultrasound of the abdomen
• Angiogram
• CT of the abdomen
• Medical treatment of toxic megacolon with close surgical observation