A 72-year-old male who complained of melena and diarrhea had total colitis type of ulcerative colitis, which was diagnosed by colonofiberscopy. During conservative therapy, marked dilatation of the transverse colon was observed in abdominal X-ray film. Therefore, he was admitted to our department for treatment of toxic megacolon. Since intensive intravenous regimen failed to improve his general condition, subtotal colectomy, mucous fistula of rectum, and Brooke ileostomy were performed. The colon became markedly dilated and thin, and perforation of the transverse colon occurred intraoperatively. Regardless of intensive care, he died from hemorrhagic gastric ulcer with multiple organ failure. Since the incidence of ulcerative colitis tends to peak in old age as well as in young age, we should pay attention to this disease even in old age. The mortality rate of ulcerative colitis complicated with toxic megacolon in old age is much higher than before then. Thus rapid diagnosis and proper therapy is necessary.
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