Intensive medical management of toxic megacolon.

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  • 中毒性巨大結腸症の治療　　保存的療法の有用性について

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Two cases of toxic megacolon associated with ulcerative colitis were successfully treated by medical therapy, one case was given steroid hormone intravenously and the other case was treated by intraarterial injection of steroid hormone through inferior and superior mesenteric arteries. It was useful to know the disease activities not only by the toxic factors but by the multiple disease activity indices to decide medical treatment or operation.<br>From 1976 to 1987, fourteen medically treated cases and 16 operative cases were reported in Japanese literatures. Eight cases were successfully treated by intraarterial steroid hormone injection therapy which was one of the most important treatments by our opinion, but one out of three undergoing surgery after intraarterial injection therapy died. So, overall mortality rate of intraarterial injection therapy was 9% The average duration of toxic megacolon was 7.1 days, among medically treated cases.<br>For these reason a policy will be recommended that; instead of the emergency earlier operation, intensive medical management including intraarterial steroid hormone injection therapy will be done, operative treatment will be undertaken after about seven days if necessary.

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