title: Aetiology and surgical management of toxic megacolon.
abstract: OBJECTIVE
  The purpose of this article is to review the surgical management and outcome of toxic megacolon and to update the aetiology of toxic megacolon.
  
  
  METHODS
  A retrospective chart review of three academic colorectal surgery units was undertaken. Over a period of 20 years, 70 patients with surgically managed toxic megacolon were identified: 32 men and 38 women, median age 63 years (range, 23-87 years).
  
  
  RESULTS
  In 33 (48%) patients the main cause of toxic megacolon was inflammatory bowel disease. Thirty-seven (52%) patients had toxic megacolon of different aetiology. Sixty-three patients underwent colonic resection: 49 (70%) subtotal colectomies and 14 (20%) total colectomies, including 4 (6%) proctocolectomies. Seven (10%) patients had decompression (n=3) or faecal diversion (n=4) only. Forty-four of the resected patients underwent a Hartmann's procedure and an ileostomy; 13 (19%) patients had primary anastomoses, 11 (16%) ileorectal anastomoses (IRA) and 2 (3%) patients had ileal pouch-anal anastomosis (IPAA). Twenty-six (37%) patients subsequently had continuity restored. Total surgical complication rate was 19% (n=13), 8% (n=4) in patients treated with subtotal colectomy, 21% (n=3) in patients treated with total proctocolectomy and 86% (n=6) in patients treated with either decompression or diversion. The total mortality rate was 16% (n=11).
  
  
  CONCLUSIONS
  Toxic colitis complicated by toxic megacolon can occur after various diseases of the colon and remains a life-threatening disorder associated with a significant risk of postoperative complications. Subtotal colectomy with ileostomy remains the procedure of choice. Surgical colonic decompression with faecal diversion alone is associated with a high rate of complications.
authors.affiliation: Department of Surgery, Danube Hospital, and Department of General Surgery, Medical University of Vienna, Austria. christoph.ausch@wienkav.at
authors.forename: C
authors.initials: C
authors.lastname: Ausch
authors.forename: R D
authors.initials: RD
authors.lastname: Madoff
authors.forename: M
authors.initials: M
authors.lastname: Gnant
authors.forename: H R
authors.initials: HR
authors.lastname: Rosen
authors.forename: J
authors.initials: J
authors.lastname: Garcia-Aguilar
authors.forename: N
authors.initials: N
authors.lastname: Hölbling
authors.forename: F
authors.initials: F
authors.lastname: Herbst
authors.forename: V
authors.initials: V
authors.lastname: Buxhofer
authors.forename: B
authors.initials: B
authors.lastname: Holzer
authors.forename: D A
authors.initials: DA
authors.lastname: Rothenberger
authors.forename: R
authors.initials: R
authors.lastname: Schiessel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008532:Megacolon, Toxic / Q000209:etiology* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies