During an acute ulcerative colitis flare, which diagnostic procedure is contraindicated?

• A. Colonoscopy
• B. Abdominal X-ray
• C. CBC
• D. Stool studies

Answer: (A)

In an acute ulcerative colitis flare, the colon is inflamed and friable, often with wall edema and potential dilation if the disease is severe. Introducing a scope with insufflation and tight instrumentation can provoke perforation or worsen toxic megacolon. That risk makes endoscopic evaluation—colonoscopy—contraindicated during a severe flare. Instead, use noninvasive or less invasive assessments to guide management: an abdominal X-ray can detect colonic dilation suggestive of toxic megacolon, CBC helps assess leukocytosis and anemia, and stool studies help rule out infectious causes that can mimic or trigger a flare. Once the patient is stabilized and inflammation subsides, colonoscopy can be considered if mucosal assessment or biopsies are needed.