title: Early surgery for the treatment of toxic megacolon.
abstract: BACKGROUND
  Toxic megacolon (TM) is a potentially lethal complication of idiopathic inflammatory bowel disease or infectious colitis, characterized by total or segmental non-obstructive colonic dilatation of at least 6 cm associated with systemic toxicity.
  
  
  METHODS
  Overall, 15 patients had surgery for TM at our institutions over a 10-year period (1993-2003). In contrast to other studies that used medical therapy as the first-line treatment for TM, in our experience all patients underwent surgery as soon as possible after diagnosis of TM (early surgery).
  
  
  RESULTS
  14 patients underwent subtotal colectomy with terminal ileostomy, while for 1 patient the surgical procedure consisted only in a decompressive cecostomy. Two major complications occurred consisting of 2 cases of multiple organ failure leading to death. No other major complications or deaths were reported. The overall mortality rate was therefore 13% (0% in patients <65 years).
  
  
  CONCLUSIONS
  This study shows that early surgery has the potential to represent a valid therapeutic strategy for patients with TM resulting in a small number of TM-related complications and deaths. Elderly patients seem to have a high risk of multiple organ dysfunction syndrome and post-surgical death.
authors.affiliation: Dipartimento di Chirurgia Generale, Piove di Sacco, University of Padua, Padua, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: D'Amico
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.forename: Imerio
authors.initials: I
authors.lastname: Angriman
authors.forename: Cesare
authors.initials: C
authors.lastname: Ruffolo
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Amico
authors.forename: Domenico
authors.initials: D
authors.lastname: Valente
authors.forename: Maurizio
authors.initials: M
authors.lastname: Berto
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vella
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.forename: Davide Francesco
authors.initials: DF
authors.lastname: D'Amico
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003082:Colectomy; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008532:Megacolon, Toxic / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D015996:Survival Rate; D016896:Treatment Outcome