My Treatment Approach to the Management of Ulcerative Colitis

Role of Loop Ileostomy in the Management of Ulcerative Colitis Patients

“…Fulminant and complicated UC patients are very fragile patients with high mortality and morbidity, they need to bekept on medical/biological therapy trials and if without response they need a definitive major surgery (colectomy) with high risk and affecting life style (3,4) .…”

“…are generally categorized as fulminant ulcerative colitis when patients with severe ulcerative colitis have more than 10 stools per day, continuous bleeding, abdominal pain, distension, and acute, severe toxic symptoms including fever and anorexia, such patients are at risk of progressing to toxic megacolon and bowel perforation were intervention must take place. (2)(3)(4) It is a chronic relapsing disease with different modes of presentation (mild,moderate, sever,andfulminant) and different modes of progress and response totherapy, the medical and gastroenterology units start the initial steps of diagnosis (clinically, endoscopically and histopathologically) and when possible, patients should be managed with aggressive medical therapy, though in some surgery will be required. In addition to proper nutritional assessment and support, a colorectal surgeon should be contacted and involved early in the patient's admission.…”

“…It is important that patientshadtried all reasonable medical therapiesprior to considering colectomy andwhen medical treatment fail to induce a response (resistant cases) to all these treatment modalities then they are referredfor surgicalmanagement. (2)(3)(4)(5) Those patients who are not candidates for definitive surgery (total proctocolectomy), with high mortality rates and can't afford treatment (total parenteral nutrition and biological treatment)were candidate forour research study by diverting the intestinal contents from the diseased colonic mucosa toallow the inflammatory process to settle down by doing a simple defunctioning loop ileostomy (DLI); which is relatively cheap, simple, short procedure and with little morbidity and mortality;aiming togive them high chance of recovering from their symptoms and signs and build up theirbody stores, as a preliminarystep either to do definite surgery later on or to retry other routes of medical therapy (4)(5)(6)(7) . In the developing country were the beds of advanced intensive care units to keep these patients for long periods of time on total parenteral nutrition (TPN) waiting for response of medical methods therapy are affordable, and most of thesepatients are incapable of affording the expenses of theTPN and the new drug regimens, it is important to exclude alternative and/or comorbid conditions as a cause for their symptoms and the evaluation should consist of laboratory studies, stool studies, flexible sigmoidoscopy, and plain abdominal radiography (6,8,9) .Then defunctioning loop ileostomy procedure was the alternative solution for these patients as theywill have the chance of either a second trial of medical therapy or towards less life threatening definitive surgery.…”