Emergency surgery of fulminant ulcerative colitis and toxic megacolon

Abstract

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.