[Surgical treatment of toxic megacolon]

After an introduction on the various aetiological factors involved in toxic megacolon, its onset, medical treatment and indications to surgery, the paper describes personal experience with seven cases. The report highlights the importance of medical treatment which is recommended as the appropriate initial therapeutic approach. Then after a review of evolving surgical techniques, it is suggested , again on the basis of personal experience, that the surgical approach should be neither excessively aggressive (total proctocolectomy with permanent ileostomy) nor excessively conservative (multistoma decompression). According to this report, the operation of choice is currently subtotal colectomy plus ileostomy and sigmoidostomy which combine modest morbidity and mortality with the possibility of future reconstruction.