A CURATIVE CASE REPORT OF PERFORATED TOXIC MEGACOLON ASSOCIATED WITH ULCERATIVE COLITIS

Abstract

A 40 year-old man was admitted to our hospital complaning of acute excerbation of ulcerative colitis on June 1983. The patient had noticed bloody stool since 1976, and he was diagnosed as ulcerative colitis on 1980. After admission he had massive bloody diarrhea and showed the sign of ileus in spite of intensive drug therapy. Physical and roentgenological examination of abdomen revealed a toxic megacolon and operation was performed. Surgical findings was obserbed severe inflammation and dilatation of the total colon with marked thin intestinal walls, and the intraabdominal hematoma was recognized at the site of perforated hepatic flexure. Thirteen surgical cases of toxic megacolon were collected in japanese literature. Four perforated cases (31%) were associated with total colitis. The most frequent perforated area was transverse colon (100%), the diameter of the dilated colon ranged from 4 to 14 cm. One third of these cases died, and in the case ofperforation, mortality was up to 50%. Thus we will emphasize that it is most important to diagnose and treat in its early stage of toxic megacolon.