Although many authors use the terms severe, toxic and fulminant interchangeably, the term fulminant ulcerative colitis describes a clinical condition associated with systemic deterioration (Fig. 1). Approximately 10% of patients initially present with severe disease [1, 2]. In the severe attack, the patient has diarrhoea frequently containing blood, with more than six bowel movements in 24 h. There will be systemic toxic effects, with a temperature of greater than 37.5°C, pulse rate over 90 beats per minute, decrease
in hemoglobin below 75% of normal value and increase of erythrocyte sedimentation rate over 30 mm/h (Fig. 2). A flat abdominal X-ray usually shows colonic wall oedema. Variable abdominal tenderness can be observed on clinical examination. Fulminant colitis, as originally described by Truelove and Witts in 1955, is characterised by sudden onset of more than ten per day bloody bowel movements, high body temperature, tachycardia, anaemia requiring blood transfusions, leukocytosis sedimentation rate over 30 mm/h and hypoalbuminemia [3, 4]. Dilated colon, abdominal distension and tenderness are often described [4, 5].
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