A reappraisal of the management of severe colitis in its fulminant phase

Abstract

The results of a policy of intensive intravenous medical treatment and early colectomy in fulminant ulcerative colitis, over a 22 year period, are described. Forty‐nine patients developed fulminant colitis; 43 received a period of intensive treatment including corticosteroids. Half (51%) of patients showed initial objective improvement. Deterioration was always heralded by a sudden increase in pulse rate, temperature or stool frequency. The mean duration of intensive medical treatment was 7.7 days. Early colectomy was performed in 20 (44%) patients because of the lack of sustained improvement and in 25 (56%) patients because of a major complication. All complications developed within the first 5 days of treatment. Toxic dilatation was present in 11 (22%) patients with only one concurrent perforation and no deaths. The perforation rate was 16% and accounted for 59% of the surgical mortality. The overall mortality in this series was 16.3% and in patients treated with the intensive medical regime 11.6%. Post‐operative complications developed in 19% of patients. No colonic perforations or deaths have occurred in 36 consecutive patients admitted since 1967. Earlier results, supporting the hypothesis that early colectomy in fulminant colitis is life‐saving, have been confirmed.