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.
Résumé
De janvier 1971 à décembre 1984, 53 malades atteints d'une colite aiguë grave caractérisée cliniquement par une température à 38°, un pouls supérieur a 100/mm et plus de 5 selles diarrhéiques sanglantes quotidiennes ont été traités. Vingt-huit (dont 12 hommes) présentaient une colite ulcéreuse et 25 (dont 13 hommes) une maladie de Crohn. La crise grave se manifesta plus tôt au cours de la maladie chez les malades atteints de maladie de Crohn. L'âge moyen pour le Crohn fut de 31 ans (17–58) et de 41 ans (17–70) pour la colite ulcéreuse. Tous les malades furent traités dans une unité gastroentérologique médicale et chirurgicale. Le traitement initial fut médical: 49 malades recurent des corticoïdes, 39 de la salazopyrine et 8 des antibiotiques. Vingt-sept malades répondirent favorablement au traitement médical en 11 jours en moyenne (3 à 30). Trois d'entre eux durent être opérés ultérieurement. Vingt-six malades durent être opérés en urgence (coloprotectomie totale: 9, colectomie totale avec anastomose iléorectale: 11, colectomie avec conservation du rectum: 6). Chez 10 malades se développa un mégacolon toxique, 9 devant être opérés d'urgence. Les autres initialement stabilisés furent colectomisés au cours de leur hospitalisation. Aucun décès ne fut à déplorer. Les complications postopératoires furent rares. Au moment de l'admission aucun facteur ne permettait de prédire la nécessité d'une intervention. Les auteurs ont la conviction que la collaboration étroite entre médecins et chirurgiens permet d'éviter la morbidité et la mortalité de la colite fulminante.
Resumen
Desde enero de 1971 hasta diciembre de 1984 tuvimos 53 pacientes con colitis aguda severa, a juzgar por temperatura de 38°C., pulso mayor de 100/min y diarrea sanguinolenta de más de 5 veces/día. Veintiocho pacientes (12 hombres) presentaban colitis ulcerativa y 25 (13 hombres) colitis de Crohn. El ataque grave ocurrió en las fases tempranas de la evolución de la enfermedad en los pacientes con colitis de Crohn. En los pacientes con enfermedad de Crohn, la edad promedio fue 31 años (rango 17–58) y en los pacientes con colitis ulcerativa, fue 41 años (rango 17–70). Todos los pacientes fueron manejados en una unidad gastroenterológica médica y quirúrgica combinada. El tratamiento inicial fue médico; 49 pacientes recibieron corticoesteroides, 39 salazoprina y 8 antibiótico. Veintisiete pacientes se estabilizaron bajo tratamiento médico en un promedio de 11 días (rango 3–30). De ellos, 3 requirieron resección posteriormente. Veintiseis pacientes requirieron operación urgente (panproctocolectomía en 9, colectomía total y anastomosis ileorectal en 11 y colectomía con conservación del recto en 6). Diez pacientes desarrollaron megacolon tóxico, y 9 requirieron cirugía urgente. El otro se estabilizó inicialmente, pero fue sometido a colectomía más tarde durante la misma admisión. No hubo muertes en esta série, y las complicaciones operatorias fueron poco frecuentes. En la admisión no se logró identificar factores que pudieran predecir la necesidad de operación. Creemos que mediante una estrecha colaboración entre internistas y cirujanos se puede evitar la mortalidad y morbilidad de colitis severa y fulminante.
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Morel, P., Hawker, P.C., Allan, R.N. et al. Management of acute colitis in inflammatory bowel disease. World J. Surg. 10, 814–818 (1986). https://doi.org/10.1007/BF01655248
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DOI: https://doi.org/10.1007/BF01655248