Management of acute colitis and toxic megacolon

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; acute colitis; ileostomy; total colectomy; toxic colitis.

Figure 1

A plain abdominal radiograph should be obtained to estimate disease extent. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 1996–2010. All rights reserved.

Figure 2

Computed tomography (CT) imaging showing acute severe colitis. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 1996–2010. All rights reserved.

Figure 3

Blow-hole colostomy and loop ileostomy. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 1996–2010. All rights reserved.

Figure 4

Subtotal/total colectomy and end ileostomy. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 1996–2010. All rights reserved.

Figure 5

The distal sigmoid can be divided, closed, and delivered to the inferior portion of the wound to reside above the fascia level. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 1996–2010. All rights reserved.

Figure 6

Total proctocolectomy and end ileostomy. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 1996–2010. All rights reserved.

Figure 7

Total proctocolectomy with ileal pouch-anal anastomosis and loop ileostomy. Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 1996–2010. All rights reserved.