Emergencies

Serious IBD complications can develop quickly and require urgent care. This article explains how to recognize red flags, what to do in the moment, and what hospital teams typically do. It focuses on life‑threatening problems like toxic megacolon, heavy gastrointestinal bleeding, severe infection, intestinal blockage, perforation, and blood clots. Simple checklists help families act fast while avoiding delays that can raise risk.

Key takeaways

• Certain symptoms are emergencies and need immediate hospital care.

• Toxic megacolon is a rare but life‑threatening complication of severe colitis.

• Heavy bleeding, severe abdominal pain with distention, fever with confusion, or signs of shock require calling emergency services.

• Infection, especially Clostridioides difficile, can mimic a flare and must be tested for in the hospital.

• People with IBD have higher blood clot risk, so sudden leg swelling or chest pain is urgent.

What counts as an IBD emergency

An IBD emergency is a sudden, severe problem that threatens the bowel or overall health. The most important are:

• Toxic megacolon in severe colitis.

• Massive lower gastrointestinal bleeding.

• Intestinal obstruction or perforation.

• Severe infection or sepsis, including abscess.

• Venous thromboembolism (VTE), blood clots in legs or lungs.

• Severe dehydration or dangerous electrolyte problems from uncontrolled diarrhea and vomiting.

Call emergency services now

Immediate transport is safer than driving when any of the following are present:

• Fainting, confusion, or trouble staying awake.

• Signs of shock, such as cold clammy skin, fast heartbeat, or low blood pressure.

• Severe, worsening abdominal pain with a swollen or rigid belly.

• Passing large amounts of bright red blood or clots.

• Sudden chest pain, coughing blood, or severe shortness of breath.

• One leg acutely swollen, painful, warm, or discolored.

Go to the emergency department the same day

Urgent evaluation is needed for:

• Fever with severe diarrhea, especially with recent antibiotic use.

• Uncontrolled vomiting, inability to keep fluids down, or signs of dehydration.

• New severe rectal pain or a painful perianal lump, which can signal an abscess.

• Severe flare symptoms not responding to usual rescue medicines.

Toxic megacolon: recognition and hospital care

Toxic megacolon is severe inflammation that causes the colon to dilate and stop moving normally. It occurs most often in extensive ulcerative colitis, but can occur in Crohn’s colitis or severe infections.

Warning signs include:

• Severe abdominal pain and distention.

• Fever, fast heart rate, weakness, or confusion.

• Very frequent bloody stools or sudden drop in stool output despite pain and swelling.

In the hospital, teams usually:

• Perform urgent evaluation, including abdominal X‑ray or CT, blood tests, and stool testing for infection.

• Start bowel rest, IV fluids, electrolytes, and broad‑spectrum antibiotics when infection risk is high.

• Give high‑dose IV corticosteroids for severe colitis if infection is ruled out or treated.

• Involve colorectal surgery early. If the colon is at risk of perforation or the patient worsens, colectomy may be lifesaving.

Other emergency complications

• Massive bleeding: Signs include dizziness, large volumes of bright blood, or black tarry stools with weakness. Care includes IV fluids, blood tests, transfusion when needed, imaging, and colonoscopy or surgery if bleeding does not stop.

• Intestinal obstruction: More common in Crohn’s disease with strictures. Clues are crampy pain, abdominal swelling, nausea, vomiting, and lack of gas or stool. Management ranges from bowel rest and nasogastric decompression to urgent surgery if there are signs of strangulation or perforation.

• Perforation: Sudden severe pain with a rigid abdomen and fever suggests a hole in the bowel. This is a surgical emergency.

• Severe infection and abscess: Fever, chills, worsening pain, or a painful perianal lump can indicate abscess. CT or ultrasound helps confirm. Treatment includes drainage and antibiotics, often before restarting or escalating immunosuppression.

• Blood clots (VTE): Hospitalization and severe flares raise clot risk. Sudden unilateral leg swelling and pain suggests deep vein thrombosis. Chest pain with shortness of breath suggests pulmonary embolism. Blood thinners are started once bleeding risk is assessed.

What to expect in the emergency department

• Assessment: Vital signs, exam, IV line, fluids, and pain control.

• Tests: Blood counts, electrolytes, C‑reactive protein, kidney and liver tests, stool for pathogens and Clostridioides difficile, pregnancy test when relevant.

• Imaging: Abdominal X‑ray for dilation, CT scan to look for obstruction, abscess, or perforation. Ultrasound for perianal or pelvic abscess.

• Treatments: IV steroids for severe colitis when appropriate, antibiotics if infection suspected, blood thinners when clot risk outweighs bleeding risk, and early surgical consultation.

A quick reference table

What information helps the hospital team

• Current medication list, doses, and last biologic or steroid dose.

• Allergies and prior surgeries.

• Contact for the gastroenterology clinic or infusion center.

• Recent test results if available, such as fecal calprotectin or scope reports.

After an emergency

• A care plan should be updated before discharge. This often includes a steroid taper plan if used, infection treatment when present, and a clear follow‑up appointment with gastroenterology, usually within 1 to 2 weeks.

• Blood clot prevention is often continued after discharge for high‑risk patients, depending on bleeding risk.

• Vaccinations and infection screening may be reviewed before restarting or escalating immunosuppressive therapy.

FAQs

How is toxic megacolon different from a bad flare

Both cause severe symptoms, but toxic megacolon includes colon dilation and signs of whole‑body toxicity. It requires hospital monitoring and often surgical input.

Can someone take home steroids instead of going to the hospital

No. Severe colitis with systemic symptoms needs IV therapy, infection testing, and close monitoring that cannot be done safely at home.

When can biologics be restarted after an abscess

After adequate drainage and antibiotics, the team often restarts or initiates biologic therapy to control inflammation. Timing is individualized based on healing and infection control.