Surgical Treatment for Ulcerative Colitis S. Tsuchiya 1 , H. Takemura 1 , Y. Matsuda 1 1Second Depatment of Surgery, Yokohama City University, School of Medicine pp.1005-1014
Published Date 1976/8/25
DOI https://doi.org/10.11477/mf.1403107382
  • Abstract
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 Indicatien of surgical treatment for ulcerative colitis is not obvious. To settle some criteria of indication and timing of operation is important. Various clinical features of our own 68 cases and the results of medical treatment of them were studied. The results are as follows.

 In our clinic 73 patients were treated in recent three years (June, 1973~March, 1976). 68 cases of them were studied.

 Age at onset ranges from 9 to 60 years old. The incidence rate rises up to the age of 20 or 30 and then begins to fall. There are 18 cases of involving the total colon (total colitis), 20 cases of implicating the left half of the colon (left sided colitis), and 30 cases of being restricted to the rectum (proctitis). Mean age at onset is youngest in total colitis patients. (26.8 years).

 Total colitis patients often accompanied with various systemic and local complications such as hypoalbuminemia, anemia, pseudopolyposis, stricture, massive hemorrhage, and acute colonic dilatation. They often failed in medical treatment. Left sided colitis and proctitis accompanied with much less complications than total colitis. All of these patients remitted by medical treatment and did not require operation.

 Operative treatment was only done in the patients with total colitis.

 Fulminant type cases should be operated if any improvement is not recognized by an intensive medical treatment of a few days duration.

 Most of the severe total colitis patients did not go into remission by four weeks intensive medical treatment and required operation. Therefore, operation is often preferable for these cases.

 10 cases of all patients (14.7%) underwent surgical treatment. Rectum-retaining operation was done in 8 cases. Overall results of this type of operation were satisfactory, notwithstanding some medically controllable anal bleeding was noticed after operation. This procedure is recommendable to over half of the cases with ulcerative colitis which require operation.

 Acute dilatation of the colon is one of the severe and life-threatening complications of ulcerative colitis and needs urgent operation. Decompression colostomy and diverting ileostomy (Turnbull's operation) was done in 21-year-old female. After one week anal bleeding and toxic signs completely disappeared, and general status was greatly improved. Total colectomy and ileorectal anastomosis was done successfully 45 days after the previous operation. Turnbull's operation may be one of life-saving procedures applicable to these cases with acute colonic dilatation.

Copyright © 1976, Igaku-Shoin Ltd. All rights reserved.


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