title: Surgical Management of Toxic Megacolon.
abstract: OBJECTIVE
  Toxic megacolon carries still a substantial mortality and the decision when to per form emergent colectomy needs precise predictors outcome.
  
  
  METHODS
  Thirty-two patients with toxic megacolon were identified from a computer database, and their clinical variables were analysed both univariate and multivariate analysis.
  
  
  RESULTS
  30-day mortality was 16%, being 17% for the patients with Clostridium difficile colitis and 13% for the patients with inflammatory bowel diseases. Diabetes, MPI class II, ASA classes 4-5, increase serum creatinine level, fever over 39 degrees, renal failure, gangrenous bowel and vasopressor requirement significantly associated with in univariate analysis, but only MPI class II and ASA classes 4-5 were independent predictors of mortality. Major complications occurred in 53% of the patients and they associated with respiratory failure, development of shock and vasopressor requirement. Surgical intensive care was needed by the patients who developed respiratory failure, shock or anaemia the hospital treatment was longer in patients with Clostridium difficile colitis.
  
  
  CONCLUSIONS
  Development of signs of organ failures or shock are associated with poorer outcome in patients with toxic megacolon and the patients should be urgently operated, when these signs occur.
authors.forename: Mäkelä Jyrki
authors.initials: MJ
authors.lastname: Tapani
authors.forename: Kiviniemi Heikki
authors.initials: KH
authors.lastname: Olavi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008532:Megacolon, Toxic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult