Surgical management of chronic ulcerative colitis.

Abstract

Summary and Conclusions All patients suffering with ulcerative colitis should be under the combined management of both internist and surgeon. Experience proves that the risk is great when operating upon patients desperately ill with acute fulminating ulcerative colitis, those with massive hemorrhage, and those with peritonitis caused by perforation. However, in the absence of these complications, the risk is little greater than that of resection of the colon for cancer. Acute fulminating ulcerative colitis should be operated upon if there is rapid deterioration of the patient caused by perforation and peritonitis. Surgical delay is justifiable only when there is improvement. Not more than one week of conservative treatment is permissible when there is no improvement. In these cases, ileostomy and subtotal colectomy, followed by proctectomy (when the patient's condition permits) are the procedures of choice. In chronic ulcerative colitis, the principal indications for operation are extreme disability and intractability, despite medical management, carcinoma, extensive mutiple polyposis, and complications such as abdominal abscesses and enterocolic and colocutaneous fistula, acute massive hemorrhage, perforation and peritonitis, partial or complete intestinal obstruction, and perineal abscesses and fistulas. The procedure of choice is complete colo-proctectomy and ileostomy performed in one stage, if the patient's condition permits. If there is some question concerning the patient's condition, ileostomy and subtotal colectomy, followed in three to six weeks by proctectomy, should be performed.