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Aetiology and surgical management of toxic megacolon
Author(s) -
Ausch C.,
Madoff R. D.,
Gnant M.,
Rosen H. R.,
GarciaAguilar J.,
Hölbling N.,
Herbst F.,
Buxhofer V.,
Holzer B.,
Rothenberger D. A.,
Schiessel R.
Publication year - 2006
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2005.00887.x
Subject(s) - medicine , toxic megacolon , ileostomy , megacolon , surgery , anastomosis , ulcerative colitis , colectomy , proctocolectomy , etiology , decompression , mortality rate , disease
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.