In a patient with ulcerative colitis and signs suggestive of toxic megacolon, what is the next best step?

• A. High-dose steroids
• B. Broad-spectrum antibiotics only
• C. Exploratory laparotomy and colectomy
• D. Colonoscopic decompression

Answer: (C)

Toxic megacolon is a life-threatening complication of ulcerative colitis where the colon becomes massively dilated and toxic, raising the risk of perforation and sepsis. In this situation, definitive management is surgical because medical therapy alone cannot promptly relieve the dilation or prevent rupture. Emergent exploratory laparotomy with colectomy removes the diseased colon and stops the imminent danger, which is why that is the best next step. While high-dose steroids and broad-spectrum antibiotics are used to stabilize and treat inflammation, they are not sufficient when signs point to toxic megacolon. Colonoscopic decompression is avoided here due to the high perforation risk in a dilated colon. So urgent colectomy directly addresses the life-threatening process, with the exact surgical plan tailored to intraoperative findings.