[Surgical procedure in fulminant colitis and toxic megacolon]

Both fulminant colitis and toxic megacolon are regarded as the sequelae of colitis in which irreversible changes in the whole thickness of colonic wall have occurred. These condition both call for an immediate, emergent surgical intervention. Until recently the procedure of choice in this acute phase of the disease was colectomy with Brooke ileostomy and Hartmann type closure of the distal rectum. Colectomy with ileal pouch anal anastomosis was reserved only for elective surgery. The improvement in surgical technique, but first of all widespread of stapling devices, have shortened the time of operation and simplified the procedure, so that creation of an ileal reservoir is currently more often performed as a one step procedure and without an increased risk. Between 1985 and 1997 in our Department, 120 patients had ileal pouches created for various conditions. There were 72 patients with ulcerative colitis in this series and 10 of them had-one-step procedure involving pouch formation in the acute phase of the disease. Multi-step procedures, including Hartmann's colectomies were performed in 16 patients. One-step operations involving ileal pouch creation in the acute phase of the ulcerative colitis are feasible in selected cases and in experienced centres. Such an approach shortens the time of treatment.