Total Proctocolectomy Resulting from Toxic Megacolon in A Young Patient with Ulcerative Rectocolitis: Systematic Review and Case Report

Introduction: Ulcerative colitis is a chronic, relapsing inflammatory bowel disease, generallybeginning between 20 and 40 years old, with an etiology that is still under debate. Methods: based on the PRISMA method, articles related to "toxic megacolon; ulcerative colitis" published in the last 5 years were identified, as well as comparing them with a case of a young patient with a rare presentation of toxic megacolon requiring total proctocolectomy. Case report: we report a rare case of ulcerative colitis without previous signs, culminating in perforated toxic megacolon requiring total proctocolectomy, with good postoperative results, describing the actions taken by the general surgery team at a reference hospital. Discussion: Total proctocolectomy with anal anastomosis with ileal pouch represents the standard approach for patients with refractory UC or complications, including toxic megacolon. The exact moment to perform surgery in patients with moderate to severe UC still remains a challenge, but several factors must be considered and medication alternatives must be offered to patients without risk factors for complications. Conclusion: it is necessary to individualize the treatment plan and the same patient may requiremultiple modalities to achieve remission or improvement in quality of life.