Skip to main content
SpringerLink
Log in

Surgery for Fulminant Colitis

  • Chapter
  • First Online:
Contemporary Coloproctology

Abstract

Fulminant colitis can be considered as an acute and progressive inflammatory disorder of the large bowel mucosa which has failed to respond to escalating medical therapy and for which surgical intervention must be considered. Ulcerative colitis (UC) remains the commonest cause of this condition, but changing patterns of disease and increasing levels of intervention mean that other causes must be frequently considered. There are considerable and ongoing advances in medical therapy for this condition which are influencing the decision to proceed to surgery. By comparison, the surgical treatment itself has changed little over the last 30 years. Optimal management requires a multidisciplinary approach with close collaboration between the gastroenterologist, surgeon, nutrition team, and colorectal nurse specialist. The key to successful management of these patients is timely surgery before large bowel perforation and before the patient is too debilitated to withstand the surgical insult. This chapter will cover the recent changes in fulminant colitis and its management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041–8.

    Article  PubMed  CAS  Google Scholar 

  2. Jones JH, Chapman M. Definition of megacolon in colitis. Gut. 1969;10(7):562–4.

    Article  PubMed  CAS  Google Scholar 

  3. Latella G, Vernia P, Viscido A, Frieri G, Cadau G, Cocco A, et al. GI distension in severe ulcerative colitis. Am J Gastroenterol. 2002;97(5):1169–75.

    Article  PubMed  Google Scholar 

  4. Gore RM, Balthazar EJ, Ghahremani GG, Miller FH. CT features of ulcerative colitis and Crohn’s disease. AJR Am J Roentgenol. 1996;167(1):3–15.

    PubMed  CAS  Google Scholar 

  5. Ahualli J. The target sign: bowel wall. Radiology. 2005;234(2):549–50.

    Article  PubMed  Google Scholar 

  6. Carbonnel F, Gargouri D, Lemann M, Beaugerie L, Cattan S, Cosnes J, et al. Predictive factors of outcome of intensive intravenous treatment for attacks of ulcerative colitis. Aliment Pharmacol Ther. 2000;14(3):273–9.

    Article  PubMed  CAS  Google Scholar 

  7. Arnell TD. Surgical management of acute colitis and toxic megacolon. Clin Colon Rectal Surg. 2004;17(1):71–4.

    Article  PubMed  Google Scholar 

  8. Travis SP, Farrant JM, Ricketts C, Nolan DJ, Mortensen NM, Kettlewell MG, et al. Predicting outcome in severe ulcerative colitis. Gut. 1996;38(6):905–10.

    Article  PubMed  CAS  Google Scholar 

  9. Cacheux W, Seksik P, Lemann M, Marteau P, Nion-Larmurier I, Afchain P, et al. Predictive factors of response to cyclosporine in steroid-refractory ulcerative colitis. Am J Gastroenterol. 2008;103(3):637–42.

    Article  PubMed  CAS  Google Scholar 

  10. Lennard-Jones JE, Ritchie JK, Hilder W, Spicer CC. Assessment of severity in colitis: a preliminary study. Gut. 1975;16(8):579–84.

    Article  PubMed  CAS  Google Scholar 

  11. Munkholm P, Langholz E, Nielsen OH, Kreiner S, Binder V. Increased incidence of Crohn’s disease in the county of Copenhagen. Ugeskr Laeger. 1993;155(40):3199–202.

    PubMed  CAS  Google Scholar 

  12. Lamontagne F, Labbe AC, Haeck O, Lesur O, Lalancette M, Patino C, et al. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg. 2007;245(2):267–72.

    Article  PubMed  Google Scholar 

  13. Johnson S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect. 2009;58(6):403–10.

    Article  PubMed  Google Scholar 

  14. Zahariadis G, Connon JJ, Fong IW. Fulminant Clostridium difficile colitis without diarrhea: lack of emphasis in diagnostic guidelines. Am J Gastroenterol. 2002;97(11):2929–30.

    Article  PubMed  Google Scholar 

  15. Greenstein AJ, Byrn JC, Zhang LP, Swedish KA, Jahn AE, Divino CM. Risk factors for the development of fulminant Clostridium difficile colitis. Surgery. 2008;143(5):623–9.

    Article  PubMed  Google Scholar 

  16. Jaber MR, Olafsson S, Fung WL, Reeves ME. Clinical review of the management of fulminant Clostridium difficile infection. Am J Gastroenterol. 2008;103(12):3195–203; quiz 204.

    Article  PubMed  Google Scholar 

  17. Koss K, Clark MA, Sanders DS, Morton D, Keighley MR, Goh J. The outcome of surgery in fulminant Clostridium difficile colitis. Colorectal Dis. 2006;8(2):149–54.

    Article  PubMed  CAS  Google Scholar 

  18. Montoro MA, Brandt LJ, Santolaria S, Gomollon F, Puertolas BS, Vera J, et al. Clinical patterns and outcomes of ischaemic colitis: results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study). Scand J Gastroenterol. 2011;46(2):236–46.

    Article  PubMed  Google Scholar 

  19. Carter MJ, Lobo AJ, Travis SP. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004;53 Suppl 5:V1–16.

    Article  PubMed  Google Scholar 

  20. Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol. 2007;5(1):103–10.

    Article  PubMed  CAS  Google Scholar 

  21. Ng SC, Kamm MA. Therapeutic strategies for the management of ulcerative colitis. Inflamm Bowel Dis. 2009;15(6):935–50.

    Article  PubMed  Google Scholar 

  22. Lichtiger S, Present DH, Kornbluth A, Gelernt I, Bauer J, Galler G, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994;330(26):1841–5.

    Article  PubMed  CAS  Google Scholar 

  23. Van Assche G, D’Haens G, Noman M, Vermeire S, Hiele M, Asnong K, et al. Randomized, double-blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis. Gastroenterology. 2003;125(4):1025–31.

    Article  PubMed  Google Scholar 

  24. Gisbert JP, Gonzalez-Lama Y, Mate J. Systematic review: infliximab therapy in ulcerative colitis. Aliment Pharmacol Ther. 2007;25(1):19–37.

    Article  PubMed  CAS  Google Scholar 

  25. Jarnerot G, Hertervig E, Friis-Liby I, Blomquist L, Karlen P, Granno C, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology. 2005;128(7):1805–11.

    Article  PubMed  Google Scholar 

  26. Aratari A, Papi C, Clemente V, Moretti A, Luchetti R, Koch M, et al. Colectomy rate in acute severe ulcerative colitis in the infliximab era. Dig Liver Dis. 2008;40(10):821–6.

    Article  PubMed  CAS  Google Scholar 

  27. Maser EA, Deconda D, Lichtiger S, Ullman T, Present DH, Kornbluth A. Cyclosporine and infliximab as rescue therapy for each other in patients with steroid-refractory ulcerative colitis. Clin Gastroenterol Hepatol. 2008;6(10):1112–6.

    Article  PubMed  CAS  Google Scholar 

  28. Goligher JC, de Dombal FT, Graham NG, Watkinson G. Early surgery in the management of severe ulcerative colitis. Br Med J. 1967;3(5559):193–5.

    Article  PubMed  CAS  Google Scholar 

  29. Kaplan GG, McCarthy EP, Ayanian JZ, Korzenik J, Hodin R, Sands BE. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology. 2008;134(3):680–7.

    Article  PubMed  Google Scholar 

  30. Cima RR. Timing and indications for colectomy in chronic ulcerative colitis: surgical consideration. Dig Dis. 2010;28(3):501–7.

    Article  PubMed  Google Scholar 

  31. Marcello PW, Milsom JW, Wong SK, Brady K, Goormastic M, Fazio VW. Laparoscopic total colectomy for acute colitis: a case-control study. Dis Colon Rectum. 2001;44(10):1441–5.

    Article  PubMed  CAS  Google Scholar 

  32. Bell RL, Seymour NE. Laparoscopic treatment of fulminant ulcerative colitis. Surg Endosc. 2002;16(12):1778–82.

    Article  PubMed  CAS  Google Scholar 

  33. Bohm G, O’Dwyer ST. The fate of the rectal stump after subtotal colectomy for ulcerative colitis. Int J Colorectal Dis. 2007;22(3):277–82.

    Article  PubMed  CAS  Google Scholar 

  34. Subramanian V, Saxena S, Kang JY, Pollok RC. Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery. Am J Gastroenterol. 2008;103(9):2373–81.

    Article  PubMed  Google Scholar 

  35. Holubar SD, Cima RR, Pemberton JH. Does infliximab increase complications after surgery for inflammatory bowel disease? F1000 Med Rep. 2009;1:10.

    Google Scholar 

  36. Subramanian V, Pollok RC, Kang JY, Kumar D. Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators. Br J Surg. 2006;93(7):793–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Queen Elizabeth Hospital, Birmingham, West Midlands, B15 2TH, UK

    Kaori Futaba FRCS

  2. Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China

    Tony Mak FRCS

  3. Academic Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK

    Dion Morton FRCS

Authors
  1. Kaori Futaba FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tony Mak FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dion Morton FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dion Morton FRCS .

Editor information

Editors and Affiliations

  1. Sheffield Teaching Hospitals NHS Foundat, Sheffield, S5 7AU, United Kingdom

    Steven R. Brown

  2. Hull Royal Infirmary, Hull, United Kingdom

    John E. Hartley

  3. Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom

    Jim Hill

  4. Hope Hospital, Manchester, United Kingdom

    Nigel Scott

  5. New Cross Hospital, Royal Wolverhampton Hospital Trust, Wolverhampton, WV10 0QP, United Kingdom

    J. Graham Williams

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag London Limited

About this chapter

Cite this chapter

Futaba, K., Mak, T., Morton, D. (2012). Surgery for Fulminant Colitis. In: Brown, S., Hartley, J., Hill, J., Scott, N., Williams, J. (eds) Contemporary Coloproctology. Springer, London. https://doi.org/10.1007/978-0-85729-889-8_19

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-889-8_19

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-888-1

  • Online ISBN: 978-0-85729-889-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation