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DOI: 10.1055/s-0030-1268254
Management of Acute Colitis and Toxic Megacolon
Publication History
Publication Date:
07 December 2010 (online)
ABSTRACT
Severe colitis is a well-defined condition that can develop in patients afflicted with ulcerative colitis, but typically responds to a variety of medical therapies. Operative intervention is warranted when massive hemorrhage, perforation, or peritonitis complicates the clinical scenario or medical therapy fails to control the disease. Of the operative options, total/subtotal colectomy and end ileostomy is the usual procedure of choice especially if the operation can be performed through a laparoscopic approach.
KEYWORDS
Ulcerative colitis - toxic colitis - acute colitis - total colectomy - ileostomy
REFERENCES
- 1 Silverberg M S, Satsangi J, Ahmad T et al.. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005; 19(Suppl A) 5-36
- 2 Brown S R, Haboubi N, Hampton J, George B, Travis S PL. ACPGBI . The management of acute severe colitis: ACPGBI position statement. Colorectal Dis. 2008; 10(Suppl 3) 8-29
- 3 Kornbluth A, Sachar D B. Practice Parameters Committee of the American College of Gastroenterology . Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010; 105(3) 501-523, quiz 524
- 4 Travis S PL, Stange E F, Lémann M et al.. Gassull M for the European Crohn's and Colitis Organisation (ECCO). European evidence-based consensus on the management of ulcerative colitis: current management. J Crohn's Colitis. 2008; 2 24-62
- 5 Truelove S C, Witts L J. Cortisone in ulcerative colitis; final report on a therapeutic trial. BMJ. 1955; 2(4947) 1041-1048
- 6 Hanauer S B. Inflammatory bowel disease. N Engl J Med. 1996; 334(13) 841-848
- 7 Marshak R H, Lester L J. Megacolon a complication of ulcerative colitis. Gastroenterology. 1950; 16(4) 768-772
- 8 Gan S I, Beck P L. A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management. Am J Gastroenterol. 2003; 98(11) 2363-2371
- 9 Sheth S G, LaMont J T. Toxic megacolon. Lancet. 1998; 351(9101) 509-513
- 10 Jones J H, Chapman M. Definition of megacolon in colitis. Gut. 1969; 10(7) 562-564
- 11 Benazzato L, D'Incà R, Grigoletto F et al.. Prognosis of severe attacks in ulcerative colitis: effect of intensive medical treatment. Dig Liver Dis. 2004; 36(7) 461-466
- 12 Travis S P, Farrant J M, Ricketts C et al.. Predicting outcome in severe ulcerative colitis. Gut. 1996; 38(6) 905-910
- 13 Seo M, Okada M, Yao T, Ueki M, Arima S, Okumura M. An index of disease activity in patients with ulcerative colitis. Am J Gastroenterol. 1992; 87(8) 971-976
- 14 Lindgren S C, Flood L M, Kilander A F, Löfberg R, Persson T B, Sjödahl R I. Early predictors of glucocorticosteroid treatment failure in severe and moderately severe attacks of ulcerative colitis. Eur J Gastroenterol Hepatol. 1998; 10(10) 831-835
- 15 Ho G T, Mowat C, Goddard C J et al.. Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second-line medical therapy or surgery. Aliment Pharmacol Ther. 2004; 19(10) 1079-1087
- 16 Carbonnel F, Gargouri D, Lémann M et al.. Predictive factors of outcome of intensive intravenous treatment for attacks of ulcerative colitis. Aliment Pharmacol Ther. 2000; 14(3) 273-279
- 17 Criscuoli V, Casà A, Orlando A et al.. Severe acute colitis associated with CMV: a prevalence study. Dig Liver Dis. 2004; 36(12) 818-820
- 18 Chew C N, Nolan D J, Jewell D P. Small bowel gas in severe ulcerative colitis. Gut. 1991; 32(12) 1535-1537
- 19 Turner D, Walsh C M, Steinhart A H, Griffiths A M. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol. 2007; 5(1) 103-110
- 20 Bossa F, Fiorella S, Caruso N et al.. Continuous infusion versus bolus administration of steroids in severe attacks of ulcerative colitis: a randomized, double-blind trial. Am J Gastroenterol. 2007; 102(3) 601-608
- 21 Gustavsson A, Halfvarson J, Magnuson A, Sandberg-Gertzén H, Tysk C, Järnerot G. Long-term colectomy rate after intensive intravenous corticosteroid therapy for ulcerative colitis prior to the immunosuppressive treatment era. Am J Gastroenterol. 2007; 102(11) 2513-2519
- 22 Lichtiger S, Present D H, Kornbluth A et al.. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994; 330(26) 1841-1845
- 23 D'Haens G, Lemmens L, Geboes K et al.. Intravenous cyclosporine versus intravenous corticosteroids as single therapy for severe attacks of ulcerative colitis. Gastroenterology. 2001; 120(6) 1323-1329
- 24 Van Assche G, D'Haens G, Noman M et al.. Randomized, double-blind comparison of 4 mg/kg versus 2 mg/kg intravenous cyclosporine in severe ulcerative colitis. Gastroenterology. 2003; 125(4) 1025-1031
- 25 Durai D, Hawthorne A B. Review article: how and when to use ciclosporin in ulcerative colitis. Aliment Pharmacol Ther. 2005; 22(10) 907-916
- 26 Actis G C, Fadda M, David E, Sapino A. Colectomy rate in steroid-refractory colitis initially responsive to cyclosporin: a long-term retrospective cohort study. BMC Gastroenterol. 2007; 7 13
- 27 Campbell S, Travis S, Jewell D. Ciclosporin use in acute ulcerative colitis: a long-term experience. Eur J Gastroenterol Hepatol. 2005; 17(1) 79-84
- 28 Rowe F A, Walker J H, Karp L C, Vasiliauskas E A, Plevy S E, Targan S R. Factors predictive of response to cyclosporin treatment for severe, steroid-resistant ulcerative colitis. Am J Gastroenterol. 2000; 95(8) 2000-2008
- 29 Järnerot G, Hertervig E, Friis-Liby I et al.. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology. 2005; 128(7) 1805-1811
- 30 Sands B E, Tremaine W J, Sandborn W J et al.. Infliximab in the treatment of severe, steroid-refractory ulcerative colitis: a pilot study. Inflamm Bowel Dis. 2001; 7(2) 83-88
- 31 Bressler B, Law J K, Al Nahdi Sheraisher N et al.. The use of infliximab for treatment of hospitalized patients with acute severe ulcerative colitis. Can J Gastroenterol. 2008; 22(11) 937-940
- 32 Lees C W, Heys D, Ho G T Scottish Society of Gastroenterology Infliximab Group et al. A retrospective analysis of the efficacy and safety of infliximab as rescue therapy in acute severe ulcerative colitis. Aliment Pharmacol Ther. 2007; 26(3) 411-419
- 33 Kohn A, Daperno M, Armuzzi A et al.. Infliximab in severe ulcerative colitis: short-term results of different infusion regimens and long-term follow-up. Aliment Pharmacol Ther. 2007; 26(5) 747-756
- 34 Maser E A, Deconda D, Lichtiger S, Ullman T, Present D H, Kornbluth A. Cyclosporine and infliximab as rescue therapy for each other in patients with steroid-refractory ulcerative colitis. Clin Gastroenterol Hepatol. 2008; 6(10) 1112-1116
- 35 Teeuwen P H, Stommel M W, Bremers A J, van der Wilt G J, de Jong D J, Bleichrodt R P. Colectomy in patients with acute colitis: a systematic review. J Gastrointest Surg. 2009; 13(4) 676-686
- 36 Crile Jr G C, Thomas Jr C Y. The treatment of acute toxic ulcerative colitis by ileostomy and simultaneous colectomy. Gastroenterology. 1951; 19(1) 58-68
- 37 Turnbull Jr R B, Hawk W A, Weakley F L. Surgical treatment of toxic megacolon. Ileostomy and colostomy to prepare patients for colectomy. Am J Surg. 1971; 122(3) 325-331
- 38 Ooi B S, Remzi F H, Fazio V W. Turnbull-Blowhole colostomy for toxic ulcerative colitis in pregnancy: report of two cases. Dis Colon Rectum. 2003; 46(1) 111-115
- 39 Remzi F H, Oncel M, Hull T L, Strong S A, Lavery I C, Fazio V W. Current indications for blow-hole colostomy:ileostomy procedure. A single center experience. Int J Colorectal Dis. 2003; 18(4) 361-364
- 40 Dinnewitzer A J, Wexner S D, Baig M K et al.. Timing of restorative proctectomy following subtotal colectomy in patients with inflammatory bowel disease. Colorectal Dis. 2006; 8(4) 278-282
- 41 Ambroze Jr W L, Wolff B G, Kelly K A, Beart Jr R W, Dozois R R, Ilstrup D M. Let sleeping dogs lie: role of the omentum in the ileal pouch-anal anastomosis procedure. Dis Colon Rectum. 1991; 34(7) 563-565
- 42 Carter F M, McLeod R S, Cohen Z. Subtotal colectomy for ulcerative colitis: complications related to the rectal remnant. Dis Colon Rectum. 1991; 34(11) 1005-1009
- 43 McKee R F, Keenan R A, Munro A. Colectomy for acute colitis: is it safe to close the rectal stump?. Int J Colorectal Dis. 1995; 10(4) 222-224
- 44 Trickett J P, Tilney H S, Gudgeon A M, Mellor S G, Edwards D P. Management of the rectal stump after emergency sub-total colectomy: which surgical option is associated with the lowest morbidity?. Colorectal Dis. 2005; 7(5) 519-522
- 45 Karch L A, Bauer J J, Gorfine S R, Gelernt I M. Subtotal colectomy with Hartmann's pouch for inflammatory bowel disease. Dis Colon Rectum. 1995; 38(6) 635-639
- 46 Ouaïssi M, Lefevre J H, Bretagnol F, Alves A, Valleur P, Panis Y. Laparoscopic 3-step restorative proctocolectomy: comparative study with open approach in 45 patients. Surg Laparosc Endosc Percutan Tech. 2008; 18(4) 357-362
- 47 Chung T P, Fleshman J W, Birnbaum E H et al.. Laparoscopic vs. open total abdominal colectomy for severe colitis: impact on recovery and subsequent completion restorative proctectomy. Dis Colon Rectum. 2009; 52(1) 4-10
- 48 Watanabe K, Funayama Y, Fukushima K, Shibata C, Takahashi K, Sasaki I. Hand-assisted laparoscopic vs. open subtotal colectomy for severe ulcerative colitis. Dis Colon Rectum. 2009; 52(4) 640-645
- 49 Marceau C, Alves A, Ouaissi M, Bouhnik Y, Valleur P, Panis Y. Laparoscopic subtotal colectomy for acute or severe colitis complicating inflammatory bowel disease: a case-matched study in 88 patients. Surgery. 2007; 141(5) 640-644
- 50 Fowkes L, Krishna K, Menon A, Greenslade G L, Dixon A R. Laparoscopic emergency and elective surgery for ulcerative colitis. Colorectal Dis. 2008; 10(4) 373-378
- 51 Binder S C, Miller H H, Deterling Jr R A. Emergency and urgent operations for ulcerative colitis. The procedure of choice. Arch Surg. 1975; 110(3) 284-289
- 52 Harms B A, Myers G A, Rosenfeld D J, Starling J R. Management of fulminant ulcerative colitis by primary restorative proctocolectomy. Dis Colon Rectum. 1994; 37(10) 971-978
- 53 Heyvaert G, Penninckx F, Filez L, Aerts R, Kerremans R, Rutgeerts P. Restorative proctocolectomy in elective and emergency cases of ulcerative colitis. Int J Colorectal Dis. 1994; 9(2) 73-76
- 54 Ziv Y, Fazio V W, Church J M, Milsom J W, Schroeder T K. Safety of urgent restorative proctocolectomy with ileal pouch-anal anastomosis for fulminant colitis. Dis Colon Rectum. 1995; 38(4) 345-349
Scott A StrongM.D.
Department of Colorectal Surgery, Cleveland Clinic
9500 Euclid Ave., Cleveland, OH 44195
Email: strongs@ccf.org