Complications
Perforation dramatically increases morbidity and mortality in the setting of toxic colitis/toxic megacolon, with a mortality rate of 27% to 57%.[33] Colectomy performed in patients with no colonic perforation carries a mortality rate of 2% to 8%, while colectomy in the face of perforation is associated with a mortality of over 40%.[22]
A leak from the staple or suture line of the transected end of the large bowel can be caused by compromised tissue integrity, impaired wound healing, or poor surgical technique. Transanal placement of a drainage tube into the out-of-circuit rectum during the early postoperative period may decrease the risk for this complication. Leaks from this area can commonly be managed with percutaneous drainage of the resultant collection and antibiotics, but operative intervention may occasionally be required.
Bleeding is a possible complication of all abdominal surgery and is not specific to toxic megacolon. The bleeding is most often managed conservatively and tends to be self-limiting. In some cases of intra-abdominal bleeding, further surgery may be necessary.
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