Myotonic dystrophy (MD) is an autosomal dominant inherit disease, slowly progressive, involving multiple organ systems. Disorders at any level of the gastrointestinal tract are relatively common and manifest as disturbances in motility, such as impaired esophageal transport, delayed gastric emptying, and megacolon. A 51 years-old man was admitted to our surgical department with obstructive symptoms. Diagnostic evaluation showed megacolon and the typical clinical features of the MD, such as weakness, myotonia, frontal baldness and testicular atrophy. Risk of perforation and dehydratation led to emergency total colectomy with ileorectal stapled anastomosis. The patient didn’t suffer for complicance related to surgical treatment but, after 1 month in intensive care, died of pneumonia and myocardial infarct. The overall frequency of perioperative complications in patients with MD ranges from 8.2 to 42.9%.The risk of perioperative pulmonarycomplications is particularly high. Thus, we believe that the conservative treatment of motility disorders of the bowel inpatients with MD is to be justified and that surgical treatment should be reserved, as last resort, performing a earlydiagnosis and careful monitoring during perioperative period.