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Aetiology and surgical management of toxic megacolon.
Colorectal Dis. 2006 Mar; 8(3):195-201.CD

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.

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.

Authors+Show Affiliations

Ausch C
Department of Surgery, Danube Hospital, and Department of General Surgery, Medical University of Vienna, Austria. christoph.ausch@wienkav.at
Madoff RD
No affiliation info available
Gnant M
No affiliation info available
Rosen HR
No affiliation info available
Garcia-Aguilar J
No affiliation info available
Hölbling N
No affiliation info available
Herbst F
No affiliation info available
Buxhofer V
No affiliation info available
Holzer B
No affiliation info available
Rothenberger DA
No affiliation info available
Schiessel R
No affiliation info available

MeSH

AdultAgedAged, 80 and overDigestive System Surgical ProceduresFemaleHumansMaleMegacolon, ToxicMiddle AgedPostoperative ComplicationsRetrospective Studies

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

16466559

Citation

Ausch, C, et al. "Aetiology and Surgical Management of Toxic Megacolon." Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, vol. 8, no. 3, 2006, pp. 195-201.
Ausch C, Madoff RD, Gnant M, et al. Aetiology and surgical management of toxic megacolon. Colorectal Dis. 2006;8(3):195-201.
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. (2006). Aetiology and surgical management of toxic megacolon. Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, 8(3), 195-201.
Ausch C, et al. Aetiology and Surgical Management of Toxic Megacolon. Colorectal Dis. 2006;8(3):195-201. PubMed PMID: 16466559.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aetiology and surgical management of toxic megacolon. AU - Ausch,C, AU - Madoff,R D, AU - Gnant,M, AU - Rosen,H R, AU - Garcia-Aguilar,J, AU - Hölbling,N, AU - Herbst,F, AU - Buxhofer,V, AU - Holzer,B, AU - Rothenberger,D A, AU - Schiessel,R, PY - 2006/2/10/pubmed PY - 2006/7/14/medline PY - 2006/2/10/entrez SP - 195 EP - 201 JF - Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland JO - Colorectal Dis VL - 8 IS - 3 N2 - 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. SN - 1462-8910 UR - https://www.unboundmedicine.com/medline/citation/16466559/Aetiology_and_surgical_management_of_toxic_megacolon_ DB - PRIME DP - Unbound Medicine ER -