Fulminant ulcerative colitis in a healthy pregnant woman

Figure 1 Abdominal computed tomography scan showing toxic megacolon during pregnancy. Ascending colon diameter was 7.6 cm, transverse colon 9.2 cm, and descending colon 5.7 cm, which was consistent with toxic megacolon. Bowel wall thickness is normal without signs of ischemic sufferance. No abdominal free gas or effusion.

Figure 2 Colonoscopy in toxic megacolon at different times of pregnancy and therapy. A: Emergency colonoscopy performed during pregnancy before starting treatment: spontaneous bleeding and denudation of the mucosal surface, which is substituted by a fibrinous layer (descending colon); B: Colonoscopy after 9 d of treatment: mucosal hyperemia and erosions, fibrinous spots (cecum); C: Colonoscopy after one-month treatment: regenerative pseudopolyps of 2-4 mm (descending colon).

Figure 3 Histopathology of active ulcerative colitis. Colonic mucosa characterized by atrophic glands with architectural distortion, mucin depletion, intense inflammatory cell infiltrate of the lamina propria rich in eosinophils, basal plasma cells, crypt abscess, and surface ulceration (A, B: Hematoxylin-eosin staining, magnification × 4; C: Hematoxylin-eosin staining, magnification × 10; D: Hematoxylin-eosin staining, magnification × 20).