[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.161.155.6. Please contact the publisher to request reinstatement.
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
April 1977

Total Proctocolectomy and IleostomyProcedure of Choice for Acute Toxic Megacolon

Author Affiliations

From the Department of Surgery, Ohio State University College of Medicine, Columbus.

Arch Surg. 1977;112(4):518-522. doi:10.1001/archsurg.1977.01370040170026
Abstract

• Of 42 critically ill patients with toxic megacolon, 31 required emergency surgery, and 11 were treated without operation. Of the 11 patients treated by medical measures alone, there were two deaths (18%): one early, secondary to undiagnosed colonic perforation, and one late death from recurrent ulcerative colitis. Nine of ten survivors (90%) experienced continued morbidity, and five (50%) required subsequent elective surgery. Thirty-one patients required emergency operation for failure of medical treatment (19), colonic perforation (ten), and uncontrolled hemorrhage (two). Early and late morbidity was 74% (two-thirds occurring after subtotal colectomy and ileostomy). Surgical mortality was 19% (8% over the last ten years).

(Arch Surg 112:518-522, 1977)

References
1.
Edwards FC, Truelove SC:  The course and prognosis of ulcerative colitis: III. Complications . Gut 5:1-22, 1964.Article
2.
Lumb G, Protheroe RHB, Ramsay GS:  Ulcerative colitis with dilatation of the colon . Br J Surg 43:182-188, 1955.Article
3.
Mclnerney GT, Sauer WG, Baggenstoss AH, et al:  Fulminating ulcerative colitis with marked colonic dilatation: A clinical pathological study . Gastroenterology 42:244-257, 1962.
4.
Peskin GW, Davis AVO:  Acute fulminating ulcerative colitis with colonic distention . Surg Gynecol Obstet 110:269-276, 1960.
5.
Binder SC, Patterson JF, Glotzer DJ:  Toxic megacolon in ulcerative colitis . Gastroenterology 66:909-915, 1974.
6.
Jalan KN, Sircus W, Card WI:  An experience of ulcerative colitis: I. Toxic dilatation in 55 cases . Gastroenterology 57:68-82, 1969.
7.
Bockus HL, Roth JLA, Buchman E, et al:  Ulcerative colitis: I. Classification of types-clinical behavior-life history-prognosis , in Jones FA (ed): Modern Trends in Gastroenterology , ed 2. New York, Paul R. Hoeber Inc, 1958, pp 296-314.
8.
Garrett JM, Sauer WG, Moertel CG:  Colonic motility in ulcerative colitis after opiate administration . Gastroenterology 53:93-100, 1967.
9.
Norland CC, Kirsner JB:  Toxic dilatation of colon (toxic megacolon): Etiology, treatment, and prognosis in 42 patients . Medicine 48:229-250, 1969.Article
10.
Smith FW, Law DN, Nickel WF Jr, et al:  Fulminant ulcerative colitis with toxic dilatation of the colon: Medical and surgical management of 11 cases with observations regarding etiology . Gastroenterology 42:233-243, 1962.
11.
Goldberg HI:  The barium enema and toxic megacolon: Cause-effect relationship? Gastroenterology 68:617-618, 1975.
12.
Scharer LL, Burhenne HJ:  Megacolon associated with administration of an anticholenergic drug in a patient with ulcerative colitis . Am J Dig Dis 9:268-274, 1964.Article
13.
Odyniec NA, Judd ES, Sauer WG:  Toxic megacolon: Significant improvement in surgical management . Arch Surg 94:638-643, 1967.Article
14.
DeDombal FT, Watts JM, Watkinson G:  Intraperitoneal perforation of the colon in ulcerative colitis . Proc R Soc Med 58:713-715, 1965.
15.
Turnbull RB Jr, Hawk WA, Weakley FL:  Surgical treatment of toxic megacolon: Ileostomy and colostomy to prepare patients for a colectomy . Am J Surg 122:325-331, 1971.Article
16.
Fry PD, Atkinson KG:  Current surgical approach to toxic megacolon . Surg Gynecol Obstet 143:26-30, 1976.
17.
 Case 19023, Case records of the Massachusetts General Hospital: Surgical department presenting case . N Engl J Med 208:94, 1933.
18.
 Case 23201, Case records of the Massachusetts General Hospital: Presentation of a case . N Engl J Med 216:894, 1937.Article
19.
 Case 27242, Case records of the Massachusetts General Hospital: Presentation of a case . N Engl J Med 224:1049, 1941.Article
20.
Chisholm TC:  Acute fulminating ulcerative colitis with massive perforation and peritonitis: Report of a case . Arch Surg 53:462-476, 1946.Article
21.
Marshak RH, Lester LJ, Friedman AI:  Megacolon, complication of ulcerative colitis . Gastroenterology 16:768-772, 1950.
22.
Madison MS, Bargen JA:  Fulminating ulcerative colitis with segmental dilatation of the colon: Report of a case . Proc Mayo Clin 26:21-24, 1951.
23.
Prohaska JV, Greer D Jr, Ryan JF:  Acute dilatation of the colon in ulcerative colitis . Arch Surg 89:24-30, 1964.Article
24.
Adams JT:  Toxic dilation of the colon: A surgical disease . Arch Surg 106:678-682, 1973.Article
25.
Sampson P, Walker FC:  Dilatation of the colon in ulcerative colitis . Br Med J 2:1119-1123, 1961.Article
26.
Goligher JC, DeDombal FT, Graham HG:  Early surgery in the management of severe ulcerative colitis . Br Med J 3:193-195, 1967.Article
27.
Roth JLA, Valder-Dapena A, Stein GN, et al:  Toxic megacolon in ulcerative colitis . Gastroenterology 37:239-255, 1959.
28.
Fazio V, Turnbull RB, Goldsmith M:  Ileostomy-colostomy for the megacolon phase of toxic ulcerative colitis , in Clearfield HR, Dinoso VP Jr (eds), Gastrointestinal Emergencies . New York, Grunne & Strattion Inc, 1976, pp 209-219.
29.
Mungus JE, Moossa AR, Block GE:  Treatment of toxic megacolon Surg Clin North Am 56:95-102, 1976.
30.
Klein SH, Edelman S, Kirschner PA, et al:  Emergency cecostomy in ulcerative colitis with acute toxic dilatation . Surgery 47:399-407, 1960.
31.
Colcock BP:  Ulcerative colitis: Indications for surgery and type of operation . Dis Colon Rectum 3:347, 1960.Article
32.
Judd ES:  Current surgical aspects of toxic megacolon . Surgery 65:401-406, 1969.
33.
Ripstein CB, Wiener EA:  Toxic megacolon . Dis Colon Rectum 16:402-408, 1973.Article
34.
Scott HW Jr, Sawyers JL, Gobbel WG Jr, et al:  Surgical management of toxic dilatation of the colon in ulcerative colitis . Ann Surg 179:647-656, 1974.Article
35.
Binder SC, Miller HH, Deterling RA Jr:  Emergency and urgent operations for ulcerative colitis . Arch Surg 110:284-289, 1975.Article
×