Fatal Case of Acute Ulcerative Colitis with Multiple Perforations

Abstract

Overmuch weight should not be given to the occurrence of post-maturity per se. For uncomplicated postmaturity no treatment is required: this also is the opinion of Clayton (1941) and of Wrigley (1946). The patient should be reassured, but she should not be admitted to hospital, for rest serves no useful purpose. A medical induction is not reliable as a test for postmaturity, nor is it likely to succeed in the case in which the head is high or the cervix is long and uneffaced.If Nothing in the foregoing remarks is intended to imply that the high head, possibly in the occipito-posterior position, is free from danger to mother and baby. These cases require ca-reful watching and management. ConclusionsPost-maturity with placental insufficiency is extremely rare. In the present series of 171 post-mature pregnancies it accounted for only one death.A foetus may die in utero for no apparent cause at any time during pregnancy. Deaths during the postmature period in the 171 post-mature cases amounted to no more thAn 9 (5.2%). In all save one of these an adequate cause for death was found.Malpresentations and cephalo-pelvic disproportion are a frequent cause of a high presenting part and a poorly formed lower uterine segment, and are hence the cause rather than the result of post-maturity.In hospital statistics the foetal mortalitSy tends to be high in post-mature cases. This is because the selection of patients is different from that of patients going into spontaneous labour at term, and failure to diagnose disproportion is common. The outstanding features in the following case are the acute onset with no previous history of ulcerative colitis and the complete lack of signs which w-ould lead to a diaqnos s of intestinal p2rforation.Case Report A housewife aged 27 was adnitted to' hospital with a history of some years' constipation and pain and bleeding from an anal fissure. The anal canal was dilated and the fissure excised. The surgeon made 'a note that there was considerable oozing from the upper rectum, which would require further investigation when the fissure had healed.Five weeks after the operation the patient was readmitted with a history of diarrhoea for the past two weeks, with blood and mucus in the stools. The abdomen was not distended but was slightly tender. Her temperature was 101.4°F. (38.55°C.). On admission she was given 100,000 units of penicillin four-hourly. Her temperature stayed at 101-103°F. (38.3-39.4' C.) for three days, when 3 g. of phthalylsulphathiazole was given four-hourly in addition to the penicillin. This reduced her temperature to normal by lysis in two days, where it stayed; but her condition deteriorated, the abdomen showing tympanitic distension and, although fairly solid, having a 'doughy feel. The motions were four or five a day and were liquid, greyish in colour, and very offensive. Repeated laboratory examinations of the blood and faeces yielded no useful information. The patient became gradually worse, and in spite of bWood and saline transfusions. she died 10 days after a -nissi...