Surgical treatment of high-risk patients with severe ulcerative colitis

Abstract

Introduction . Ulcerative colitis (UC) is an idiopathic autoimmune disease of the colon of unknown etiology, which is characterized by recurrent and intermittent inflammation with ulceration of the mucous membrane. In severe course often, a life-threatening condition requires a multidisciplinary approach with the participation of a gastroenterologist and surgeon. In approximately 25–30% of patients with UC, surgical treatment plays a key role. The timing of the operation depends on the effectiveness of conservative therapy and definitely affect the overall outcome of treatment. Postponing surgery, especially in severe, «critical» patients, is associated with an increased risk of postoperative complications and mortality. Purpose of the study is to analyze the results of surgical treatment of patients with ulcerative colitis and undifferentiated severe colitis. Materials and methods . The data of 15 patients aged from 19 to 83 operated in the period from January 2013 to May 2017 about severe ulcerative colitis. Results . The majority of patients (11 patients) underwent surgery on a planned and urgent basis, and the main indications were the ineffectiveness of conservative treatment. Mainly performed radical operations of large volume, usually with the imposition of ileostomy. In the early postoperative period, two patients died, urgently operated for toxic dilation and perforation of the intestine. Conclusions . Timely implementation of radical surgery for severe ulcerative colitis can avoid severe intestinal complications. Compliance with the optimal volume and technique of interventions can improve immediate results; reduce the incidence of perioperative complications in high-risk patients.