An experience of ulcerative colitis. I. Toxic dilation in 55 cases.

Abstract

A series of 55 cases of toxic dilation occurring in a group of 399 cases of ulcerative colitis is described. “Toxic dilation” of the colon in ulcerative colitis is shown to result in a high mortality. Perforation of the colon, massive hemorrhage and bacteremia are more common than in colitis without dilation and adversely affect prognosis. Therefore, it is imperative to find ways for the early recognition of cases at risk. The outcome appears to be modified by sex, the length of history of the disease, and the duration of the present attack, but is not significantly influenced by age, extent of involvement of the colon, mode of onset, or whether the complication appears in a first attack or relapse. Prognosis has improved since the introduction of intensive care including corticosteroids and protein replacement, but deterioration and death still occurred in more than one-third. Most of the patients treated conservatively who died did so within 10 days. For this reason, a policy is recommended that, once the complication has been recognized, surgery be undertaken with the minimum of delay.