Some physicians are comfortable managing persistent megacolon for up to seven days in patients with no overt signs of perforation or worsening toxicity. Practically, the decision to proceed with surgery is almost certainly made on a case-by-case basis with a view to the patient’s present condition and comorbidities. It is important to note that, if missed, mortality from perforation is 40%, as opposed to 8% or less if surgery is performed in a more controlled setting.
Since this article was published, there have been reports of the use of tacrolimus or infliximab as rescue therapy for UC patients with TM, with the avoidance of emergency surgery. Immunosuppressive therapy may become another tool for clinicians whose patients do not want surgery or who may not survive a prolonged procedure. When an operation is indicated, the optimal procedure, avoiding unnecessary risk, is a subtotal colectomy with end-ileostomy. Gan and Beck also cite evidence supporting decompression with a blowhole colostomy procedure for patients with either severe toxicity or known perforation. Dreaming of a reliable pharmacy to find and spend less money?