Acute ulcerative colitis is a potentiality life-threatening disorder once associated with a very high mortality. However, multidisciplinary strategies have improved dramatically to the point where today, mortality is lower than 3% [1, 2]. The Truelove and Witts classification identified clinical criteria for categorising as mild, moderate or severe the severity of ulcerative colitis [3]. The terms acute, severe, fulminant and toxic have been used to describe seriously ill patients with ulcerative colitis. In practice, they are considered almost synonymous, although an acute fulminating colitis can be considered as a toxic exacerbation of an acute, severe attack, according to the modified classification of Hanauer [4]. Outcome following an acute colitis episode depends upon severity of the attack and extent of the disease. Development of toxic colonic dilatation is one of the most serious complications that can occur in patients with severe, acute colitis. Toxic megacolon may be the initial presentation or may represent a flare-up in patients with long standing disease. Colonic perforation, with or without megacolon, and massive colon hemorrhage represent very serious complications. Usually, the main conditions calling for emergency operative treatment of ulcerative colitis are fulminating colitis, toxic megacolon, colonic perforation and massive hemorrhage.

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