Toxic megacolon: ultimate fate of patients after successful medical management.

The clinical course and ultimate outcome in 38 patients with toxic megacolon who were successfully treated nonoperatively has been reviewed. Thirty-two patients had ulcerative colitis and 6 had Crohn's disease. Follow-up was complete and ranged from 3 to 22 years (average 13 years). Eleven of 38 patients (29 percent) eventually suffered second episode of fulminant acute colitis or recurrent toxic megacolon. Ultimately, a total of 18 patients (47 percent) underwent colon resection, which was performed on an emergency or urgent basis in 15 patients. A modified Visick classification was employed to assess the long-term results of medical therapy in the entire group, in patients showing improvement within 48 or 72 hours, in patients 30 years or younger, in patients whose initial presentation of inflammatory bowel disease was toxic megacolon, and in patients with ulcerative colitis as opposed to Crohn's disease. The results were equally poor for all subgroups, and they have strengthened our opinion that medical management of toxic megacolon should be regarded almost exclusively as preparation for imminent surgery.