Medical Treatment of Acute Toxic Ulcerative Colitis

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THE treatment of the desperately ill toxic patient with fulminating ulcerative colitis is a medical problem that challenges the ingenuity and knowledge of the practitioner. Not infrequently the patience of the physician is exhausted and he recommends an ileostomy as a “life-saving measure.” Bargen,1 however, has repeatedly stressed the fact that the surgical mortality in these patients is high, while the medical mortality is relatively low. They are poorly nourished, febrile, in negative nitrogen balance, and are poor surgical risks. Consequently, it would seem that intensive medical treatment would have more to offer these patients than surgery.

At the Cleveland Clinic, surgery is reserved largely for those patients with ulcerative colitis who present complications of the disease. Approximately 13 per cent are operated on here, as compared with 26 per cent at the Lahey Clinic,2 and 5.5 per cent at the Mayo Clinic.1

There is no specific medical treatment for the acutely ill, toxic patient with ulcerative colitis. The principal purpose of treatment is to improve his nutrition and to decrease the inflammation of the colon. The treatment of each patient is different and must be individualized. The results are frequently gratifying with the toxicity of the patient and the inflammation of the colon subsiding, and the nutrition improving. Frequently, the acutely ill, toxic patient improves remarkably and is left with little or no residual.

Recently we had the opportunity of treating 2 patients acutely ill with ulcerative colitis with gratifying results. Several relatively new therapeutic aids employed were apparently. . .



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