Aetiology and surgical management of toxic megacolon

• Published in: Colorectal disease Vol. 8; no. 3; pp. 195 - 201
• Main Authors: Ausch, C., Madoff, R. D., Gnant, M., Rosen, H. R., Garcia-Aguilar, J., Hölbling, N., Herbst, F., Buxhofer, V., Holzer, B., Rothenberger, D. A., Schiessel, R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2006
• Subjects: Adult; aetiology; Aged; Aged, 80 and over; Digestive System Surgical Procedures - methods; Female; Humans; Male; Megacolon, Toxic - etiology; Megacolon, Toxic - surgery; Middle Aged; Postoperative Complications; Retrospective Studies; surgical management; Toxic megacolon
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2005.00887.x

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. Patients and method  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.