Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
European Surgery
Published in: European Surgery 3/2017

01-06-2017 | review

Surgery of acute severe ulcerative colitis. Subtotal colectomy: when and how to do it?

Authors: Rosario Fornaro, MD, PhD, Elisa Caratto, Michela Caratto, Camilla Sticchi, Alexander Salerno, Rita Bianchi, Stefano Scabini, Marco Casaccia

Published in: European Surgery | Issue 3/2017

Login to get access

Summary

Purpose

The aim of this review is to focus attention on the role of surgery in the management of acute ulcerative colitis (UC). UC is a chronic inflammatory disease of the mucosa of the large intestine.

Methods

We have examined the data from the literature of the past 20 years and we have analyzed the role of emergency surgery. A medical literature search was conducted using Medline, Embase, Ovid Journals, and Science Direct.

Results

Acute severe colitis (ASC) occurs in 12–25% of patients affected by UC. Patients with ASC should be managed by a multidisciplinary team. Aggressive medical or surgical treatment is undertaken with the final aim of reducing mortality. Intravenous corticosteroids are the mainstay of therapy. Medical rescue therapy based on cyclosporine or infliximab should be considered if there is no response to corticosteroids after 3 days. In the event that there has been no response to medical rescue therapy after 4–7 days, the patient must undergo urgent colectomy surgery. Prolonged observation is counterproductive as over time it increases the risk of toxic megacolon and of perforation burdened with a very high mortality rate.

Conclusions

The best possible treatment is represented by subtotal colectomy with ileostomy and preservation of a long rectal stump. Emergency colectomy is characterized by high morbidity and low mortality rates.
Literature
1.
Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19(A):5A.CrossRefPubMed
2.
3.
Bennis M, Tiret E. Surgical management of ulcerative colitis. Langenbecks Arch Surg. 2012;397(1):11–7.CrossRefPubMed
4.
5.
Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol. 2007;5:103–10.CrossRefPubMed
6.
Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2004;99(7):1371–85.CrossRefPubMed
7.
Travis SPL, Stange EF, Lemman M, Oresland T, Bemelman WA, Chowers Y, et al. European evidence based consensus on the management of ulcerative colitis: current management. J Crohns Colitis. 2008;2:24e62.
8.
Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults. Am J Gastroenterol. 2010;105(3):501–23.CrossRefPubMed
9.
Dignass A, Lindsay JO, Sturm A, Windsor A, Colombel JF, Allez M, et al. Second european evidence-based consensus on the diagnosis and management of ulcerative colitis: current management. J Crohns Colitis. 2012;6(10):991–1030.CrossRefPubMed
10.
11.
Hyman NH, Cataldo P, Osler T. Urgent subtotal colectomy for severe inflammatory bowel disease. Dis Colon Rectum. 2005;48:70–3.CrossRefPubMed
12.
Heppell J, Farkouh E, Dubé S, Péloquin A, Morgan S, Bernard D. Toxic megacolon. An analysis of 70 cases. Dis Colon Rectum. 1986;29(12):789–92.CrossRefPubMed
13.
Miniello S, Marzaioli R, Balzanelli MG, Dantona C, Lippolis AS, Barnabà D, et al. Toxic megacolon in ulcerative rectocolitis. Current trends in clinical evaluation, diagnosis and treatment. Ann Ital Chir. 2014;85(1):45–9.PubMed
14.
Gan SI, Beck PL. A new look at toxic megacolon: an update and review of incidence, etiology, pathogenesis, and management. Am J Gastroenterol. 2003;98:2363–71.CrossRefPubMed
15.
Greenstein AJ, Barth JA, Sachar DB, Aufses AH Jr.. Free colonic perforation without dilatation in ulcerative colitis. Am J Surg. 1986;152(3):272–5.CrossRefPubMed
16.
Dignass A, Eliakim R, Magro F, Maaser C, Chowers Y, Geboes K, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohns Colitis. 2012;6:965–90.CrossRefPubMed
17.
Fornaro R, Caratto M, Barbruni G, Fornaro F, Salerno A, Giovinazzo D, et al. Surgical and medical treatment in patients with acute severe ulcerative. Colitis J Dig Dis. 2015; doi:10.​1111/​1751-2980.​12278.PubMed
18.
European Crohn’s and Colitis Organisation (ECCO), Øresland T, Bemelman WA, Sampietro GM, Spinelli A, Windsor A, Ferrante M, et al. European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis. 2015;9(1):4–25.
19.
Criscuoli V, Casà A, Orlando A, Pecoraro G, Oliva L, Traina M, et al. Severe acute colitis associated with CMV: a prevalence study. Dig Liver Dis. 2004;36:818–20.CrossRefPubMed
20.
21.
Canadian Association of Gastroenterology Severe Ulcerative Colitis Consensus Group, Bitton A, Buie D, Enns R, Feagan BG, Jones JL, Marshall JK, et al. Treatment of hospitalized adult patients with severe ulcerative colitis: Toronto consensus statements. Am J Gastroenterol. 2012;107(2):179–94, author reply 195 doi:10.​1038/​ajg.​2011.​386.CrossRef
22.
Campbell S, Travis S, Jewell D. Ciclosporin use in acute ulcerative colitis: a long-term experience. Eur J Gastroenterol Hepatol. 2005;17:79–84.CrossRefPubMed
23.
Moskovitz DN, Van Assche G, Maenhout B, Arts J, Ferrante M, Vermeire S, et al. Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol. 2006;4:760–5.CrossRefPubMed
24.
Hultén L. Proctocolectomy and ileostomy to pouch surgery for ulcerative colitis. World J Surg. 1998;22:335–41.CrossRefPubMed
25.
Hata K, Kazama S, Nozawa H, Kawai K, Kiyomatsu T, Tanaka J, et al. Laparoscopic surgery for ulcerative colitis: a review of the literature. Surg Today. 2015;45(8):933–8.CrossRefPubMed
26.
Telem DA, Vine AJ, Swain G, Divino CM, Salky B, Greenstein AJ, et al. Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come. Surg Endosc. 2010;24(7):1616–20.CrossRefPubMed
27.
Balachandran R, Tøttrup A. Safety of proctocolectomy for ulcerative colitis under elective and non-elective circumstances: preoperative corticosteroid treatment worsens outcome. Dig Surg. 2015;32(4):251–7.CrossRefPubMed
28.
Gu J, Stocchi L, Remzi FH, Kiran RP. Total abdominal colectomy for severe ulcerative colitis: does the laparoscopic approach really have benefit? Surg Endosc. 2014;28(2):617–25.CrossRefPubMed
29.
Bartels SA, Gardenbroek TJ, Ubbink DT, Buskens CJ, Tanis PJ, Bemelman WA. Systematic review and metaanalysis of laparoscopic versus open colectomy with end ileostomy for non-toxic colitis. Br J Surg. 2013;100(6):726–33.CrossRefPubMed
30.
Chung TP, Fleshman JW, Birnbaum EH, Hunt SR, Dietz DW, Read TE, et al. Laparoscopic vs. open total abdominal colectomy for severe colitis: impact on recovery and subsequent completion restorative proctectomy. Dis Colon Rectum. 2009;52(1):4–10.CrossRefPubMed
31.
Cohen JL, Strong SA, Hyman NH, Buie WD, Dunn GD, Ko CY, Fleshner PR, et al. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum. 2005;48(11):1997–2009.CrossRefPubMed
32.
Ross H, Steele SR, Varma M, Dykes S, Cima R, Buie WD, et al. Practice parameters for the surgical treatment of ulcerative colitis. Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2014;57(1):5–22.CrossRefPubMed
33.
Geltzeiler CB, Lu KC, Diggs BS, Deveney KE, Keyashian K, Herzig DO, et al. Initial surgical management of ulcerative colitis in the biologic era. Dis Colon Rectum. 2014;57(12):1358–63.CrossRefPubMed
34.
Dunker MS, Bemelman WA, Slors JF, van Hogezand RA, Ringers J, Gouma DJ. Laparoscopic-assisted vs open colectomy for severe acute colitis in patients with inflammatory bowel disease (IBD): a retrospective study in 42 patients. Surg Endosc. 2000;14(10):911–4.CrossRefPubMed
35.
Gu J, Stocchi L, Remzi F, Kiran RP. Factors associated with postoperative morbidity, reoperation and readmission rates after laparoscopic total abdominal colectomy for ulcerative colitis. Colorectal Dis. 2013;15(9):1123–9.PubMed
36.
McKee RF, Keenan RA, Munro A. Colectomy for acute colitis: is it safe to close the rectal stump? Int J Colorectal Dis. 1995;10(4):222–4.CrossRefPubMed
37.
Gu J, Stocchi L, Remzi F, Kiran RP. Intraperitoneal or subcutaneous: does location of the (colo)rectal stump influence outcomes after laparoscopic total abdominal colectomy for ulcerative colitis? Dis Colon Rectum. 2013;56(5):615–21.CrossRefPubMed
38.
Alves A, Panis Y, Bouhnik Y, Maylin V, Lavergne Slove A, Valleur P. Subtotal colectomy for severe acute colitis: a 20-year experience of a tertiary care center with an aggressive and early surgical policy. J Am Coll Surg. 2003;197(3):379–85.CrossRefPubMed
39.
Hyman NH, Cataldo P, Osler T. Urgent subtotal colectomy for severe inflammatory bowel disease. Dis Colon Rectum. 2005;48(1):70–3.CrossRefPubMed
40.
Langholz E, Munkholm P, Davidsen M, Binder V. Colorectal cancer risk and mortality in patients with ulcerative colitis. Gastroenterology. 1992;103:1444–51.CrossRefPubMed
41.
Metadata
Title
Surgery of acute severe ulcerative colitis. Subtotal colectomy: when and how to do it?
Authors
Rosario Fornaro, MD, PhD
Elisa Caratto
Michela Caratto
Camilla Sticchi
Alexander Salerno
Rita Bianchi
Stefano Scabini
Marco Casaccia
Publication date
01-06-2017
Publisher
Springer Vienna
Published in
European Surgery / Issue 3/2017
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-016-0458-5

Other articles of this Issue 3/2017

European Surgery 3/2017 Go to the issue

original article

Oxidative stress and angiogenesis in primary hyperparathyroidism

review

Preoperative nutritional counseling versus standard care prior to bariatric surgery

editorial

Behind and beyond surgery

original article

Caudate resection for primary and metastatic liver tumors

original article

Impact of ultrasound examination shortly after kidney transplantation

original article

Fecal occult blood test/fecal carcinoembriogenic antigen dual rapid test as a useful tool for colorectal cancer screening