Dialatation of the colon (toxic megacolon) in acute fulminating ulcerative colitis.

DURING the past decade there appears to have been an increase in the incidence of chronic nonspecific ulcerative colitis in the southwest. Since 1949, I have removed all, or a part , of the colon and rectum f rom 40 patients suffering with this disease. This is a relatively small num be r of patients, but it is significant that only twe i'teostomies had been performed for ulcerative colitis in the same hospital prior to that time. In ten patients 0f this group, with acute fuhninat ing disease, the colon became dilated, usuaIly the transverse portion, and the dilatation vffried in degree f rom moderate severity to massive enlargement. The significance :6f the unusually high incidence of this complication remains unexplained. Th i s :unknown feature and the gravity of the complication are responsible for this study. A careful review of medical l i terature has been made in an a t tempt to find a solution to some :of the a t tendant problems, especially determinat ion of the op t imum time for surgical intervention and the appropr ia te surgical procedure to employ. My experience in connection with these problems will be related in this presentation.