TOXIC MEGACOLON IN ULCERATIVE COLITIS.

Toxic dilatation of the colon is now a well-recognized complication of ulcerative colitis. Our experience with four cases is presented. The clinical picture was characterized by severe ulcerative colitis with increasing abdominal distension, high swinging temperatures, obvious toxicity, and a moderate to high leukocytosis with a pronounced shift to younger forms. Accurate history and physical examination, plain radiographs of the abdomen, sigmoidoscopy and, most important of all, awareness of the condition facilitate diagnosis in most cases. The main indications for surgical intervention are progressive abdominal distension and impending or actual perforation. Ileostomy and subtotal or total colectomy are the surgical procedures of choice. We feel that steroids play little part in the early management, but are of value in the early postoperative period. The three patients in our series treated surgically survived. One treated by medical means alone died of peritonitis.