Colite aiguë grave: traitement chirurgical

Severe acute colitis: Surgical treatment

Résumé

La colite aiguë grave (CAG) est une urgence médicochirurgicale. La chirurgie est indiquée avant tout traitement médical intensif en cas de complications qui sont la perforation colique, l’hémorragie massive, le syndrome toxique, la colectasie et en cas d’échec du traitement médical. La colectomie subtotale avec iléostomie et sigmoïdostomie est l’intervention de référence et peut être réalisée par laparoscopie. Les résultats opératoires sont satisfaisants en l’absence de CAG compliquée. Après colectomie subtotale, le rétablissement de la continuité digestive se fait habituellement par une anastomose iléo-anale en cas de rectocolite hémorragique et iléorectale en cas de maladie de Crohn.

Abstract

Severe acute colitis is both a medical and surgical challenge. Surgery is required before intensive medical treatment in case of complications i.e. colonic perforation, massive haemorrhage, toxic syndrome, colectasia and in case of failure of medical therapy. Subtotal colectomy with ileostomy and sigmoidostomy remains the operation of choice and can be performed by laparoscopy with low postoperative morbidity. Results are satisfactory in the absence of complicated severe acute colitis. After subtotal colectomy, digestive continuity is usually performed by ileal pouch-anal anastomosis for ulcerative colitis and by ileorectal anastomosis for Crohn’s disease.

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Correspondence to Y. Panis.

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Bretagnol, F., Panis, Y. Colite aiguë grave: traitement chirurgical. Colon Rectum 2, 22–25 (2008). https://doi.org/10.1007/s11725-008-0073-0

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Mots clés

  • Colite aiguë grave
  • Colectomie subtotale
  • anastomose iléo-anale
  • Anastomose iléorectale

Keywords

  • Severe acute colitis
  • Subtotal colectomy
  • Ileal-anal anastomosis
  • Ilorectal anastomosis