Emergency surgery of fulminant ulcerative colitis and toxic megacolon

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2007 (EN)
Emergency surgery of fulminant ulcerative colitis and toxic megacolon (EN)

Mikrou J.,
Semoglou Ch.,
Natsikas B.,
Dalainas B.,
Trygonis K.,

SUMMARY Subtotal colectomy and ileostomy (SCI) is now urgently used as the life-saving management of the severe, life - threatening, progressions in the course of ulcerative colitis (UC). PURPOSE. To evaluate the efficacy of SCI in patients with severe colitis, we reviewed our own experience in 12 patients with this condition. METHODS. Patients undergoing SCI included 6 males and 6 females aged 12 to 56 years (mean 35,8 years). The duration of the disease averaged 29 months (range 4 to 92 months). Three had had their disease less than 6 months. Eleven patients had total colitis and only one patient had left-sided colitis. Three patients endured a continuous course and in 9 the course was intermittent. All were anemic with protein concentration less than 5 gm/dl at the time of surgery. Five patients had fulminant colitis with severe hemorrhage and seven patients with pancolitis developed toxic megacolon with unrecognized perforation in one case preoperatively. All patients underwent an emergency SCI with either intrapelvic oversewing the rectum (7 patients) or exteriorizing it as a mucus fistula (5 patients). One patient with toxic megacolon died in the first postoperative day because of uncontroled septic shock. The remainder 11 patients survived and later underwent rectectomy, anal mucosectomy and ileal pouch anal anastomosis (IPAA). CONCLUSION. SCI for patients with fulminant ulcerative colitis and toxic megacolon is a life-saving procedure which gives the chance for ileal pouch anal anastomosis (IPAA) a second time. Key Words: Ulcerative colitis, fulminant colitis, toxic megacolon, subtotal colectomy. (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 15, No 1 (2002) (EN)

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