Early surgery in the management of severe ulcerative colitis.

Abstract

Recently we also described a large series of cases with severe attacks of ulcerative colitis, the fatality rate of which was considerable, being 9.6% in severe first attacks and 13.7% in severe relapses (de Dombal et al., 1965a

Fate of the rectum and distal colon after subtotal colectomy for ulcerative colitis.

“…Even though the overall operative mortality rate is stated to be no greater for total proctocolectomy than for subtotal colectomy (Black and Sholl, 1954;Scarborough, 1955;Goligher, de Dombal, Graham, and Watkinson, 1967) in the surgeon's judgment the patient might not tolerate the additional trauma of a rectal dissection while an elective resection can be done later with much less risk. This is certainly true when the indication for surgery is colonic perforation or toxic dilatation.…”

Ulcerative colitis: definition, historical background, aetiology, diagnosis, naturel history and local complications

“…Indeed there is powerful evidence to suggest that emotional factors may be of some importance in maintaining or prolonging an existing attack of colitis. It is well known that feelings of anxiety or resentment may be accompanied by several changes in the colonic mucosa, comprising an increase in tone, in lysozyme secretion, and in intracolonic pressures; furthermore the mucosa may become hyperaemic and secrete a thick tenacious mucus (Grace, Wolf & Wolff, 1951). These physiological studies have extreme importance, in that they provide powerful evidence in favour of the contention that attacks of colitis are more prolonged and severe in the presence of an adverse psychological reaction; and they provide powerful support for the inclusion in conservative management of this disease of a 'common sense' form of psychotherapy during an acute, troublesome attack (see p. 698).…”

“…We, therefore, decided in 1964, as a result of our studies, that we would in future invoke the aid of radical surgery at an early stage of all severe attacks (including first attacks), unless there was unequivocal evidence of rapid improvement upon a conservative regime. A more recent publication (Goligher et, al., 1967) has shown considerable initial success for this policy. No patient has died in a first attack of ulcerative colitis since 1963; and the overall mortality in all severe attacks of the disease (assessed according to the criteria of Truelove & Witts, 1955) has been only 1-3%as against 11-3% in the previous decade.…”

Traitement médical de la RCH grave: lesquels et jusqu’où?

“…réalisation d'une colectomie précoce [1]. Depuis, trois médicaments se sont révélés actifs dans la RCH sévère ou corticorésistante et ont réduit le taux de colectomie en urgence.…”