Implications of abnormal pathology in fulminating colitis on the outcome of surgery.
BACKGROUND
The severe relapse of the diseases in patients with Crohn's disease or ulcerative colitis is associated with high morbidity and mortality. Early prediction for the failure of aggressive medical treatment and consequently, early surgical interference in cases with severe colitis and severe Crohn's colitis are supposed to be effective means for reducing these high rates.


METHODS
Patients who presented at the Accident & Emergency Department with severe colitis and severe Crohn's colitis and on whom emergency colectomy was operated were identified and they formed the basis of this study.


RESULTS
Patients (n=34) with acute fulminating colitis and their condition required emergency colectomy were seen over a period of 5 years. A strategy of early detection of cases of toxic dilatation and/or perforation proved efficient in reducing morbidity and mortality in cases of severe colitis. The mortality in the presented series was zero and the morbidity occurred mainly in such cases that presented with fulminant distal colitis, which was complicated by proximal faecal loading.


CONCLUSIONS
Diagnosis of proximal faecal loading in cases with fulminant colitis is likely to be an indication for surgery. Further studies are required for confirming this conclusion.
El-Tawil
A M
AM
Department of Surgery, University Hospital of Birmingham, C13 Nuffield House, Edgbaston B15 2TH, United Kingdom.