Acute ulcerative colitis

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Abstract
IN A SERIES Of 282 cases of ulcerative colitis treated by the author, 34 (12 per cent) were seriously ill with acute complications. The disease in these patients has been classified as acute ulcerative colitis, but it could be described as "fulminating" to add emphasis to the gravity of the disorder. However, the term "fulminating" implies an explosive, lightning-quick illness and this was not often true of the cases presented herewith. In this series four types of complications were responsible for the acute condition. Toxemia: The most common complication was extreme toxemia. Invariably there was gross ulceration of the mucous membrane of a large portion of the colon. Often the patient had intense diarrhea, but it was the general toxic effect of the disease that was the most prominent feature. Physical weakness, nausea and vomiting were the rule. The patient looked ill; the pulse was rapid and the temperature was elevated (104 ° F. was observed frequently). The abdomen was tender over the position of the colon. Ulcerated mucous membrane was observed on rectal examination and sigmoidoscopy revealed fecal serosanguineous discharges in the rectum, coming from inflammatory changes of the mucosa. Distention: The second common acute manifestation was abdominal distention produced by accumulation of gas and discharges in the colon and the small bowel. In some cases obstruction was caused by segmental colitis, but in others the colon was more diffusely involved and the cause was obscure. These patients exhibited varying degrees of toxic effects of ulcerative colitis, but the abdominal distention was the most alarming feature. Hemorrhage: A much less common manifestation of acute involvement was hemorrhage. In this group excessive bleeding originated from deep ulceration in the rectum and anal canal. These patients also presented features of toxicity, but it was the severe hemorrhage which required urgent intervention. Perforation: Another acute manifestation encountered was perforation. It was either intraperitoneal or extraperitoneat and, in the latter instance, it caused perirectal and perianal sepsis. The effect of this complication superimposed upon the existing toxic ulcerative colitis produced an alarming deterioration of the patient's condition. Analysis of Cases (Table 1)