30th July 2023

A 28-year-old man with a history of ulcerative colitis is admitted to hospital with worsening abdominal pain and stool frequency

A 28-year-old man with a history of ulcerative colitis is admitted to hospital with worsening abdominal pain and stool frequency. He is known to have mild-moderate left-sided colitis and is currently on a maintenance therapy of oral mesalamine. In the past few weeks, his symptoms have been worsening, and he is awaiting a clinic appointment with the gastroenterology team. He says he has started taking co-codamol over the last couple of days due to abdominal discomfort. He feels that the abdominal pain has not responded to the analgesia and instead he feels worse. On examination, his abdomen is notably distended, and he is diffusely tender.

Observations: temperature 37.9°C, heart rate 106 bpm, blood pressure 98/60 mmHg,

An abdominal x-ray was performed.

What is the most likely explanation for symptoms?

Select the SINGLE most appropriate option from the list below. Select ONE option only.