Surgical Management of Toxic Megacolon

Toxic megacolon carries still a substantial mortality and the decision when to per form emergent colectomy needs precise predictors outcome.

Thirty-two patients with toxic megacolon were identified from a computer database, and their clinical variables were analysed both univariate and multivariate analysis.

30-day mortality was 16%, being 17% for the patients with Clostridium difficile colitis and 13% for the patients with inflammatory bowel diseases. Diabetes, MPI class II, ASA classes 4-5, increase serum creatinine level, fever over 39 degrees, renal failure, gangrenous bowel and vasopressor requirement significantly associated with in univariate analysis, but only MPI class II and ASA classes 4-5 were independent predictors of mortality. Major complications occurred in 53% of the patients and they associated with respiratory failure, development of shock and vasopressor requirement. Surgical intensive care was needed by the patients who developed respiratory failure, shock or anaemia the hospital treatment was longer in patients with Clostridium difficile colitis.

Development of signs of organ failures or shock are associated with poorer outcome in patients with toxic megacolon and the patients should be urgently operated, when these signs occur.