Surgical treatment of toxic megacolon and proposal for a program of therapy

Experience with 12 patients with toxic megacolon that required surgical intervention is described and analyzed. Ten patients had ulcerative colitis and 2 had Crohn's colitis; 9 were treated with corticosteroids before operation. The diagnosis was established by radiologic studies, operative findings and examination of the surgical specimens. The operations performed in these patients were proctocolectomy and ileostomy in five, abdominal colectomy and ileostomy with preservation of the rectum in five, and loop ileostomy and colonic venting in two. All patients had prolonged and complicated recovery periods; 1 died in the postoperative period and 10 reassumed their pre-illness activities. A highly specific therapy program is proposed for managing patients with toxic megacolon.