Abstract
In accordance with a policy of early colectomy for severe ulcerative colitis, urgent/emergency surgery was performed in 132 patients during the last decade. The indication for surgery was toxic megacolon (45 cases), massive hemorrhage (6 cases), and fulminating colitis not responding to medical treatment within 4 days (81 cases). The operations performed were proctocolectomy (9 cases, mostly of hemorrhage), colectomy plus ileorectal anastomosis (3 cases), and abdominal colectomy plus ileostomy plus proctostomy (CIP) (120 cases, including 45 of toxic megacolon). Secondary proctectomy (SP) was later performed in 113 CIP cases.
A major distinction of this series is a colonic perforation rate of only 3% (9% in toxic megacolon). Mortality after urgent/emergency colectomy was 5.3%. Total mortality within 2 years (including SP) was 6.8%. Two of 4 patients with colonic perforation died, as did 1 patient with colonic cancer. Postoperative complications occurred in 40% of the patients after urgent/emergency colectomy, and in 52% after all surgery combined (including SP). Mortality and morbidity were higher in toxic megacolon and in patients older than 60 years. Late complications, mostly persisting perineal sinuses, were seen in 31%.
We believe that the low colonic perforation rate, and the subsequent favorable mortality and morbidity, are the results of our policy of early colectomy. Also, this study lends support to the choice of abdominal colectomy plus ileostomy plus proctostomy (and subsequent secondary elective proctectomy) when urgent/emergency surgery is indicated for severe ulcerative colitis.
Résumé
Suivant une politique de colectomie précoce en cas de colite ulcéreuse grave, nous avons, au cours des 10 dernières années, opéré en urgence ou semiurgence 132 malades. Les indications opératoires ont été le mégacÔlon toxique (45 cas), l'hémorragie massive (6 cas) et la colite fulminante n'ayant pas répondu en 4 jours au traitement médical (81 cas). Les opérations réalisées ont été la proctocolectomie (9 cas, surtout pour hémorragie), la colectomie avec iléorectostomie (3 cas) et la colectomie par voie abdominale avec iléostomie et proctostomie (120 cas, y compris les 45 mégacÔlons toxiques). Une amputation ultérieure du rectum fut réalisée dans 113 de ces cas.
Une première remarque s'impose pour cette série: elle ne comporte que 3% de perforations (9% pour les mégacÔlons toxiques). La mortalité après chirurgie d'urgence a été de 5.3%. La mortalité après 2 ans, y compris les amputations secondaires du rectum, a été de 6.8%. Sur 4 malades avec perforation colique, 2 sont décédés, ainsi qu'un malade atteint de cancer colique. Des complications postopératoires sont survenues chez 40% des malades après colectomie d'urgence, et chez 52% pour toute la chirurgie, y compris les amputations secondaires du rectum. La mortalité et la morbidité sont plus élevées dans le mégacÔlon toxique et chez les malades de plus de 60 ans. Nous avons eu 31% de complications tardives, surtout des fistules périnéales peristantes.
Nous estimons que la rareté des perforations coliques et, en conséquence, la mortalité et la morbidité favorables résultent de notre politique de colectomie précoce. Les résultats de cette étude sont également en faveur de la colectomie abdominale avec iléostomie et proctostomie (et amputation secondaire du rectum) lorsqu'une chirurgie d'ursecondaire du rectum) lorsqu'une chirurgie d'urgence est indiquée en cas de colite ulcéreuse grave.
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Albrechtsen, D., Bergan, A., Nygaard, K. et al. Urgent surgery for ulcerative colitis: Early colectomy in 132 patients. World J. Surg. 5, 607–614 (1981). https://doi.org/10.1007/BF01655016
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DOI: https://doi.org/10.1007/BF01655016