title: Total proctocolectomy and ileostomy: procedure of choice for acute toxic megacolon.
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).
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000601:surgery*; D003125:Colostomy; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007416:Intestinal Perforation / Q000401:mortality / Q000601:surgery; D008297:Male; D008532:Megacolon, Toxic / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality