Management of fulminating ulcerative colitis

A series of 69 patients with fulminating ulcerative colitis (UC), treated in 1976-89, was reviewed to evaluate the lines of conservative and surgical methods used. Fifty-six of the patients (81%) were operated on during the first hospitalization period: 33 patients (48%) underwent an emergency or urgent operation, and 23 (33%) received elective surgical treatment. The mortality rate was 4.3%; three patients died after emergency operations. Excluding the 14 patients who underwent immediate surgery within the first 48 hours, a significant difference could be observed in the response to conservative treatment with and without TPN: with TPN remission was achieved in 34 of 44 cases (77%), without it in only two cases of 11 (18%), P less than 0.001. Proctocolectomy used as an emergency or urgent measure resulted in two deaths, and 93% of the patients showed complications, whereas subtotal colectomy with ileostomy resulted in no deaths and significantly fewer patients (31%) had complications, P less than 0.001. The findings suggest that TPN and bowel rest, in addition to corticosteroid treatment, may be advantageous in all cases of fulminant UC. If this 'Oxford regimen' is insufficient, subtotal colectomy with ileostomy is the safest emergency operation.