Management of toxic megacolon: the significance of early recognition in medical management.

Twenty-seven patients with acute toxic dilatation of the colon (TM) as a complication of inflammatory disease of the colon are reported. To emphasize the importance of early recognition and therapy, we separated the patients into two groups: 19 were receiving care by the authors (series A) before the development of TM, and eight were seen in consultation after its onset (series B), TM subsided with medical therapy in 13 episodes among 19 patients in series A and two of eight B. The others underwent surgical therapy. There were no deaths in either group. The differences in management and mortality from other reports suggest a program of surveillance and therapy for this life-threatening situation.