Toxic megacolon: physiopathologic mechanism and surgical choices

Toxic megacolon is the most dreadful complication arising in patients affected with inflammatory bowel diseases. Its incidence is rather rare, bur mortality rate is significantly high (about 40% of cases). Pathological modifications occurring in toxic megacolon deeply influence evolution and prognosis of this complication and, consequently, surgical choices. Starting from the pathophysiology of toxic megacolon, the Authors review their experience with acute colitis, emphasizing the need for a radical treatment, as only total colectomy can assure, versus Turnbull's operation or more decompression of the bowel. To save the colon means, in fact, to leave the source of sepsis "in situ". The authors experienced Turnbull's procedure only in one of the patients observed with "quoad vitam" poor results.