Management of acute colitis in inflammatory bowel disease

Abstract

From January 1971 to December 1984, fifty‐three patients presented with severe acute colitis, defined clinically as a temperature above 38°C., a pulse above 100/min, and bloody diarrhea more than 5 times/day. Twenty‐eight patients (12 male) had ulcerative colitis, 25 patients (13 male) had Crohn's colitis. The severe attack occurred earlier in the course of the disease in Crohn's colitis. The mean age for those with Crohn's disease was 31 years (range 17–58) and 41 years (range 17–70) for those with ulcerative colitis. All patients were managed on a combined medical and surgical gastrointestinal unit. The initial treatment was medical; 49 patients received corticosteroids, 40 salazopyrine, and 7 antibiotics. Twenty‐seven patients settled on medical treatment in a mean of 11 days (range 3–30). Of these, 3 required resection later. Twenty‐six patients required urgent operation (panproctocolectomy in 9, total colectomy and ileorectal anastomosis in 11, and colectomy with retention of rectum in 6). Ten patients developed toxic megacolon, 9 requiring urgent surgery. The other one initially settled but had a colectomy later on during the admission. There were no deaths in this series. Postoperative complications were uncommon. No factors on admission could predict the need for an operation. We believe that with close cooperation between experienced physicians and surgeons, mortality and morbidity from severe, fulminating colitis can be avoided.