Toxic megacolon occurs in a number of conditions where the colon is severely inflamed: ulcerative colitis, Crohn’s disease, ischaemic colitis, severe Salmonella infections and occasionally in pseudo-membranous enterocolitis. But most of the problems occur in ulcerative colitis. In a severe attack a patient will develop toxic megacolon with diarrhoea involving at least six bowel movements, tachycardia, raised erythrocyte sedimentation rate (ESR), leukocytosis, decreased haemoglobin and lowered plasma albumin. Toxic dilatation was defined as a colon, which is more than 5.5 cm in diameter in the middle of the transverse colon where it crosses the spine . This must be associated with an irregular mucosa or mucosal islands. The outcome of a severe attack of ulcerative colitis can largely be predicted in the first 24 h by the temperature and the bowel frequency. If the temperature is lower than 38°C and there are fewer than 8 bowel actions in 24 h, four out of 5 cases of ulcerative colitis will respond to medical treatment. Also the decreasing serum albumin was important as well as the radiographic changes recorded on plain x-rays of the abdomen .