Surgical management of toxic megacolon

Toxic megacolon developed in ten of 220 patients (4.5%) admitted for chronic ulcerative colitis over the past 11 years. Nine of these patients came under the care of the Surgical Department. Only three of these 10 patients had previously been treated with steroids. Steroid therapy reversed the acute process in three patients (33%). All three patients later came to surgery. Toxic megacolon developed during the first episode of ulcerative colitis in seven of ten patients (70%). Three of the seven (43%) had perforated their colons prior to operation. Two patients died after a subtotal colectomy and one without operation. A delayed diagnosis was associated with sepsis in five patients (50%) and with all three deaths. Seven patients survived proctocolectomy. Prolonged medical management without dramatic response appeared to correlate with a high postoperative morbidity. This study supports the concept of aggressive diagnosis and early surgical intervention for toxic megacolon.