[Primary manifestation of Chrohn's disease with toxic megacolon in a patient with long-time primary sclerosing cholangitis].

A 38-year-old man with a ten year long history of primary sclerosing cholangitis without previous symptoms of inflammatory bowel disease was admitted to hospital after a few weeks with abdominal pain, diarrhoea and fever. A computed tomography revealed that the colon was dilated to a diameter of 17 cm. Based on a diagnosis of toxic megacolon, a subtotal colectomy and an ileostomy were carried out. Gross and histological examination showed changes compatible with Crohn's disease. Ten years' history of primary sclerosing cholangitis before onset of inflammatory bowel disease is very unusual, and toxic colon as the initial symptom of Crohn's disease is rare.