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A Journal on Surgery

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Chirurgia 2005 April;18(2):89-92

language: Italian

Toxic Megacolon

Donisi M., Salvati V., Romano E., Simeoli I., Muto G., Avallone U.


Toxic megacolon, a complication of many inflammatory pathologies of the colon, is the atonic acute dilatation of the colon associated with partial or segmentary necrosis. Owing to its silent onset, diagnosis is rarely timely enough with the result that mortality is estimated at 11-16% in the absence of perforation. The patient's poor condition, the wait for a relative improvement for the sake of greater operating safety on the one hand and the frequent worsening of the patient which often leads to the decision-making algorithm precipitating towards the most unpleasant hypotheses on the other, today make the timing of surgery a Solomonic controversy. The presentation of these clinical cases, in their detailed diagnostic, therapeutic and prognostic phases exemplify our conviction that this problem cannot be solved on the basis of rigid decision-making protocols but through a lucid, accurate observation of the clinical course which presents an extremely variable pattern and speed, and careful evaluation of the radiological picture.

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