CHRONIC ulcerative colitis, a rare lesion in infancy,1 presents particular problems of management. Although childhood chronic ulcerative colitis was described first by Helmholz2 in 1923 and a number of cases have been reported since,3-5 it is a diagnosis made reluctantly, in part because of the possibility of surgical intervention with the consequence of lifetime ileostomy. Indications for surgery in childhood chronic ulcerative colitis in some instances are clear cut, eg, perforation, bleeding, or obstruction. The continual and real threat that colon carcinoma will develop with long-term disease also may make surgery imperative. A more difficult decision regarding surgical intervention is the case of recurrent bouts of diarrhea.
Toxic megacolon may be defined as an acute dilatation of the proximal colon occurring in a patient with chronic ulcerative colitis; it is associated with abdominal distension, debilitation, fever, dehydration, and prostration. Although toxic megacolon can, on occasion, complicate pediatric