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A case of toxic megacolon accompanied by complicated ulcerative colitis was reported in this paper. 31 years old male patient have been transfered to our hospital complaining melena. Romanoscopy and selective superior-inferior mesenteric arteriography revealed active stage ulcerative colitis. Systemic hydrocortison administration was started immediately. On the 3rd hospital day, the abdominal dilatation was noticed and plain abdominal x-Ray film revealed remarkable dilatation by toxic megacolon on the 8th hospital day. After selective administration of hydrocortison into the superior-inferior mesenteric arteries, the cecostomy was made. Dilatation of transverse colon was decreased and melena was improved. But since the 14 th hospital day, these sign aggravated again. On 10th day after cecostomy, total colectomy was carried out considering the general condition. However, patient died of sepsis and respiratory insufficiency on 17 th post operative day. Conservative treatment was considered not to be continued over three days. Considering the pathophysiology of toxic megacolon and its toxicity, one stage operation seemes to be more beneficial than multi-stage surgery.