Background: Ulcerative colitis (UC) is an inflammatory bowel disease (IBD), which affects mainly the young adults of either sex. It has been estimated that between 30 to 50% of the female patients with UC will have an exacerbation during pregnancy or in the early postpartum period. A rare but potentially fatal complication of UC is toxic megacolon. Case Report: We describe the case of a 22-year-old multiparous married woman in the puerperal period, she had been suffering from a chronic gastro-intestinal problem for two years, which was exacerbated after delivery. Her clinical condition remains undiagnosed despite prominent signs and symptoms with laboratory investigations suggestive of complication of inflammatory bowel disease (IBD). Conclusion: Gross findings on autopsy and histopathology ruled out other differential diagnoses for toxic megacolon due to UC. This rare case highlights the exacerbation of UC in postpartum (puerperal) period. Autopsy findings in such cases are crucial in deciding allegations of medical negligence.