Among 195 patients with ulcerative colitis 30 had acute complications--toxic megacolon with or without perforations. In 16 primary treatment consisted of proctocolectomy in one stage: all patients died. Since 1971, 14 were treated by primary multiple enterostomies, with only three deaths. Indications for the latter procedure are given if after 48-72 hours of conservative treatment there is no response. Definitive treatment consists, almost without exception, of secondary proctocolectomy during the period of remission. Indications for the two-stage procedure should be extended to all acute cases requiring operation.

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