<prompt> A known case of ulcerative colitis presented to emergency with abdominal distension tenderness. X ray abdomen is given below. Which of the following is true regarding patient condition?Toxic megacolonRarely seen in ulcerative colitisSigmoid volvulusAdhesions  <response>: Given scenario suggests diagnosis of toxic megacolon in a known case of ulcerative colitis patient X ray abdomen shows dilated transverse colon 6 cm It is more commonly seen in ulcerative colitis than crohn disease Can be triggered by electrolyte abnormalities and narcotics Massive dilatation of colon leads to necrotic thin walled colon causing perforation Rx- Medical management- Fluids, IV antibiotics suppoive Total abdominal colectomy with ileostomy 