Toxic Fulminant Colitis

Toxic colitis is a severe, life threatening complication manifested as a sudden, and deteriorating clinical condition, bloody diarrhoea, peristaltic abdominal pain, development of toxaemia, emaciation and high fever. Previously believed to be more common in the case of ulcerative colitis, it is now currently proven, based on conducted studies, to be the case in up to 50% of Crohn's disease. When toxic colitis is accompanied by a dilatation of the large intestine, toxic megacolon develops. Fibrosis and stenosis of intestinal walls in Crohn's disease may result in an X-ray without intestinal dilatation that is so characteristic for toxic megacolon. Treatment of toxic colitis should be carried out in an intensive care unit and include aggressive fluid transfusions, intravenous steroids and antibiotic administration, total parenteral nutrition and metabolic monitoring. A lack of response to the treatment for 5-7 days is an indication for surgical treatment. Operative treatment is taken up earlier when symptoms of perforation, massive bleeding and toxic colitis complicated by toxic megacolon are present. Surgical procedures indicated in such cases are colectomy with ileostomy, proc-tocolectomy with ileostomy, and loop ileostomy. Presently, the golden standard in toxic colitis surgical treatment is colectomy with ileostomy [91-93]. Patients undergoing this operation are at lower risk of complication and a lower mortality rate postoper-atively compared to proctocolectomy. That publications report that an initial clinical diagnosis of the disease resulting eventually in toxic colitis, confirms itself in a later histopathological evaluation in 65-70%, which leads to the conclusion that colecto-my with preservation of the rectum allows later reconstructive surgeries. Proctocolectomy is no longer a recommended surgical procedure in the treatment of toxic colitis because it creates the risk of a large amount of intraoperative blood loss, makes the time of the surgery longer, increases the likelihood for pelvic infection and slows down the healing of the perineal wound, which is the most frequently occurring complication of the operation [94].

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