Toxic megacolon in ulcerative colitis

During a 10-year period toxic megacolon occurred in 21 patients out of 296 with ulcerative colitis. The majority had a brief history, and half were over 40 years. A barium enema, which presumably may provoke dilatation of the colon, had been performed within the past week in 8 cases. The ulcerative colitis involved the entire colon in 85%, whereas the dilatation affected predominantly the transverse segment. Fourteen patients were on steroid medication when the dilatation developed. Operation was indicated in 20 patients (colectomy with ileostomy and preserved rectum). Six patients died postoperatively, half of pulmonary complications. Only one death occurred among 6 patients with perforation of the colon. Postoperative complications arose in 80%. Both complication rate and mortality were independent of steroid medication. Mortality was lowest among patients treated by a team of internists and surgeons specialized in gastroenterology. This was presumably due to an earlier recognition of the colonic dilatation, intensive medical treatment of severe attacks even before the dilatation had developed, and careful supervision for timing the operation, which should never be delayed in favour of attempts at steroid treatment.