[Indications for surgery from the point of view of an internist]

I discussed indications for surgical intervention in cases of ulcerative colitis and Crohn's disease, based on the results of our experience at both Tohoku University Hospital and Sendai National Hospital as well as the data of collective studies carried out by the Investigation and Research Committee for Inflammatory Bowel Disease organized by the Japanese Ministry of Health and Welfare. Particularly, I stressed usefulness of a 5-day intensive intravenous regimen which was developed by Truelove and Jewell in 1974, as the best method for determining if urgent surgery is indicated in cases of acute severe or fulminant types of ulcerative colitis. Emergency surgery is required in severe cases where symptoms do not disappear or are not improved with the application of this regimen. Thus, ulcerative colitis can be safely controlled by medical management unless we misjudge the timing for surgical intervention. In addition, we mentioned hypercoagulability as a factor in both diseases. Particularly, 2 severe cases of ulcerative colitis at Sendai National Hospital were accompanied with disseminated intravascular coagulation syndrome (DIC) and one of these patients died after emergency surgery. Investigation of blood coagulation offers very important information concerning severity, prognosis and the advisability of surgical intervention. When marked hypercoagulability and intravascular coagulation syndrome are present, the therapeutic program must include anticoagulant therapy and surgical intervention.