Does Surgical Intervention Within 48 Hours Improve Postoperative Outcomes in Ulcerative Colitis Complicated by Megacolon?

BackgroundIntravenous glucocorticoids have been suggested as first-line therapy for patients with ulcerative colitis (UC) and megacolon. However, there is no definite consensus regarding the timing of surgical intervention when medical therapy fails.MethodsData were collected from 56 consecutive patients diagnosed with megacolon UC who underwent surgery between January 2000 and September 2024. Patients who underwent surgery within 48 h of the diagnosis were defined as the early group, and those who underwent surgery after 48 h were defined as the delayed group. The short-term surgical outcomes were compared between the 2 groups, and the factors associated with postoperative complications were investigated.ResultsAmong the 56 patients with megacolon, 37 were categorized into the early group and 19 into the delayed group. There was a tendency toward a lower incidence of severe postoperative complications (Clavien-Dindo grade ≥3) in the early group than in the delayed group with statistical significance (P = .043). Furthermore, the risk of colonic perforation significantly increased when more than 48 h had passed since diagnosis (P = .0015). A multivariate analysis identified colonic perforation as a significant risk factor for severe postoperative complications.DiscussionWe suggest that surgical intervention within 48 h may reduce the incidence of colonic perforation in the treatment of UC complicated by megacolon, thereby potentially decreasing the risk of severe postoperative complications.