{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T14:29:32Z","timestamp":1758637772579},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"666","license":[{"start":{"date-parts":[[1981,4,1]],"date-time":"1981-04-01T00:00:00Z","timestamp":354931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1981,4,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>The incidence, predisposing factors, management and outcome of toxic megacolon (TM) has been reviewed in 65 cases of severe ulcerative colitis (UC) and compared in 2 successive 6-year periods before and after January, 1973. Nineteen episodes of TM occurred in 18 patients. Despite a conscious aim towards earlier surgery in recent years this was not achieved, and despite more intensive medical therapy the incidence of TM was unchanged. Emergency operative mortality in UC fell from 36% to 21% but the mortality of TM remained at 30%. The chief cause of death was colonic perforation. Mortality was associated with increased age, longer pre-operative hospital stay and lower levels of serum albumin. These findings reemphasize the need for earlier surgery if TM is to be prevented, but such a policy must result in some unnecessary emergency colectomies.<\/jats:p>","DOI":"10.1136\/pgmj.57.666.223","type":"journal-article","created":{"date-parts":[[2008,12,29]],"date-time":"2008-12-29T20:43:59Z","timestamp":1230583439000},"page":"223-227","source":"Crossref","is-referenced-by-count":10,"title":["Toxic megacolon in ulcerative colitis: a continuing challenge"],"prefix":"10.1093","volume":"57","author":[{"given":"T J","family":"Muscroft","sequence":"first","affiliation":[{"name":"Department of Surgery, East Birmingham Hospital , Birmingham 9"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P M","family":"Warren","sequence":"additional","affiliation":[{"name":"Department of Medicine, East Birmingham Hospital , Birmingham 9"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Asquith","sequence":"additional","affiliation":[{"name":"Department of Medicine, East Birmingham Hospital , Birmingham 9"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R D","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Department of Medicine, East Birmingham Hospital , Birmingham 9"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G S","family":"Sokhi","sequence":"additional","affiliation":[{"name":"Department of Surgery, East Birmingham Hospital , Birmingham 9"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1981,4,1]]},"reference":[{"key":"ref_1","first-page":"174","article-title":"Importance of early intensive treatment in severe attacks of ulcerative colitis","volume":"6","author":"BARANY, F.; LINDHOLMER, B.","year":"1974","unstructured":"BARANY, F. & LINDHOLMER, B. (1974) Importance of early intensive treatment in severe attacks of ulcerative colitis. Rendiconti di Gastroenterologia, 6, 174.","journal-title":"Rendiconti di Gastroenterologia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/S0016-5085(74)80165-4","article-title":"Toxic megacolon in ulcerative colitis","volume":"66","author":"BINDER, S.C.; PATTERSON, J.F.; GLOYZER, D.J.","year":"1974","unstructured":"BINDER, S.C., PATTERSON, J.F. & GLOYZER, D.J. (1974) Toxic megacolon in ulcerative colitis. Gastroenterology, 66, 909.","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/BF02634493","article-title":"Indications for emergency colectomy in ulcerative colitis","volume":"11","author":"BROOKE, B.N.","year":"1968","unstructured":"BROOKE, B.N. (1968) Indications for emergency colectomy in ulcerative colitis. Diseases of the Colon and Rectum, 11, 85.","journal-title":"Diseases of the Colon and Rectum"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1136\/gut.20.1.22","article-title":"Measurement of serum proteins during attacks of ulcerative colitis as a guide to patient management","volume":"20","author":"BUCKELL, N.A.; LENNARD-JONES, J.E.; HERNANDEZ, M.A.; KHAN, J.; RICHES, P.G.; WADSWORTH, J.","year":"1979","unstructured":"BUCKELL, N.A., LENNARD-JONES, J.E., HERNANDEZ, M.A., KHAN, J., RICHES, P.G. & WADSWORTH, J. (1979) Measurement of serum proteins during attacks of ulcerative colitis as a guide to patient management. Gut, 20, 22.","journal-title":"Gut"},{"key":"ref_5","article-title":"Ileostomy-colostomy for the megacolon phase of toxic ulcerative colitis","author":"FAZIO, V.; TURNBULL, R.B.; GOLDSMITH, M.","year":"1976","unstructured":"FAZIO, V., TURNBULL, R.B. & GOLDSMITH, M. (1976) Ileostomy-colostomy for the megacolon phase of toxic ulcerative colitis. In: Gastrointestinal Emergencies (Ed by Clearfield, H.R. & Dinoso, V.P.). Grune and Stratton, New York."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1136\/bmj.4.5737.703","article-title":"Surgical treatment of severe attacks of ulcerative colitis, with special reference to the advantages of early operation","volume":"4","author":"GOLIGHER, J.C.; HOFFMAN, D.C.; DOMBAL, D.E.; T, F.","year":"1970","unstructured":"GOLIGHER, J.C., HOFFMAN, D.C. & DE DOMBAL, F.T. (1970) Surgical treatment of severe attacks of ulcerative colitis, with special reference to the advantages of early operation. British Medical Journal, 4, 703.","journal-title":"British Medical Journal"},{"key":"ref_7","first-page":"68","article-title":"An experience of ulcerative colitis 1. Toxic dilatation in 55 cases","volume":"51","author":"JALAN, K.N.; SIRCUS, W.; CARD, W.I.; FALCONER, C.W.A.; BRUCE, J.","year":"1969","unstructured":"JALAN, K.N., SIRCUS, W., CARD, W.I., FALCONER, C.W.A. & BRUCE, J. (1969) An experience of ulcerative colitis 1. Toxic dilatation in 55 cases. Gastroenterology, 51, 68.","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1136\/gut.10.7.562","article-title":"Definition of megacolon in colitis","volume":"10","author":"JONES, J.H.; CHAPMAN, M.","year":"1969","unstructured":"JONES, J.H. & CHAPMAN, M. (1969) Definition of megacolon in colitis. Gut, 10, 562.","journal-title":"Gut"},{"key":"ref_9","first-page":"751","article-title":"Ileorectal anastomosis for ulcerative and Crohn's colitis","volume":"135","author":"KUBACHANDI, I.T.; TRIMPI, H.D.; SHEETS, J.A.; STASIK, J.J.; KLECKNER, F.S.","year":"1976","unstructured":"KUBACHANDI, I.T., TRIMPI, H.D., SHEETS, J.A., STASIK, J.J. & KLECKNER, F.S. (1976) Ileorectal anastomosis for ulcerative and Crohn's colitis. American Journal ofSurgery, 135, 751.","journal-title":"American Journal ofSurgery"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1136\/bmj.2.5192.96","article-title":"Fulminating ulcerative colitis: recent experience in management","volume":"2","author":"LENNARD-JONES, J.E.; VIVIAN, A.B.","year":"1960","unstructured":"LENNARD-JONES, J.E. & VIVIAN, A.B. (1960) Fulminating ulcerative colitis: recent experience in management. British Medical Journal, 2, 96.","journal-title":"British Medical Journal"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/00005792-196905000-00003","article-title":"Toxic dilatation of the colon (toxic megacolon): etiology, treatment and prognosis in 42 patients","volume":"48","author":"NORLAND, C.C.; KIRSNER, J.B.","year":"1969","unstructured":"NORLAND, C.C. & KIRSNER, J.B. (1969) Toxic dilatation of the colon (toxic megacolon): etiology, treatment and prognosis in 42 patients. Medicine. Baltimore, 48, 229.","journal-title":"Medicine. Baltimore"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1136\/bmj.2.5260.1119","article-title":"Dilatation of the colon in ulcerative colitis","volume":"2","author":"SAMPSON, P.A.; WALKER, F.C.","year":"1961","unstructured":"SAMPSON, P.A. & WALKER, F.C. (1961) Dilatation of the colon in ulcerative colitis. 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(1976) The surgical management of toxic dilatation of the colon. Annals of Surgery, 184, 682.","journal-title":"Annals of Surgery"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1136\/bmj.2.4947.1041","article-title":"Cortisone in ulcerative colitis: final report on a therapeutic trial","volume":"2","author":"TRUELOVE, S.C.; WITTS, L.J.","year":"1955","unstructured":"TRUELOVE, S.C. & WITTS, L.J. (1955) Cortisone in ulcerative colitis: final report on a therapeutic trial. British Medical Journal, 2, 1041.","journal-title":"British Medical Journal"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/S0140-6736(74)90552-2","article-title":"Intensive intravenous regimen for severe attacks of ulcerative colitis","volume":"i,","author":"TRUELOVE, S.C.; JEWELL, D.P.","year":"1974","unstructured":"TRUELOVE, S.C. & JEWELL, D.P. (1974) Intensive intravenous regimen for severe attacks of ulcerative colitis. 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British Journal of Surgery, 64, 77.","journal-title":"British Journal of Surgery"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/57\/666\/223\/50216220\/postgradmedj-57-223.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/57\/666\/223\/50216220\/postgradmedj-57-223.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T17:59:50Z","timestamp":1683741590000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/57\/666\/223\/7050409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1981,4,1]]},"references-count":20,"journal-issue":{"issue":"666","published-online":{"date-parts":[[1981,4,1]]},"published-print":{"date-parts":[[1981,4,1]]}},"URL":"https:\/\/doi.org\/10.1136\/pgmj.57.666.223","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[1981,4]]},"published":{"date-parts":[[1981,4,1]]}}}