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Surgical Management for Patients with Toxic Megacolon due to Ulcerative Colitis
Toshifumi Watanabe1, Daijiro Higashi1, Hiroki Kaida1
1Department of Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Journal of the Anus, Rectum and Colon
|August 1, 2024
Summary
Toxic megacolon (TM) requires early recognition using criteria like Narabayashi and SIRS. Prompt surgical intervention is crucial for managing TM, even with incomplete clinical findings, to improve patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Critical Care Medicine
Background:
- Toxic megacolon (TM) presents diagnostic challenges due to variable severity and lack of standardized criteria.
- Early identification and management are critical for improving patient outcomes in TM cases.
Purpose of the Study:
- To review surgical management of Toxic megacolon (TM) cases.
- To summarize surgical timing and techniques for TM.
- To identify key factors for successful surgical management of TM.
Main Methods:
- Single-center retrospective study of TM patients undergoing surgery (1985-2020).
- Validation of diagnostic and sepsis screening criteria (SIRS, qSOFA, MEWS).
- Analysis of preoperative clinical features and perioperative findings.
Main Results:
- Nine patients (64.3%) met Narabayashi criteria; 10 (71.4%) met SIRS criteria.
- Two patients (14.3%) experienced intestinal perforation, with a 50% mortality rate in these cases.
- Eleven patients (78.6%) underwent total colectomy with end ileostomy.
Conclusions:
- TM diagnosis necessitates considering various findings due to ill-defined criteria and varied presentations.
- Narabayashi and SIRS criteria are recommended indicators for TM toxicity.
- Early surgical consideration for TM is vital, even if all clinical criteria are not met.
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