Article

The Treatment of Chronic Ulcerative Colitis

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Abstract

Results of Conservative Therapy

ALTHOUGH most patients with chronic ulcerative colitis do well without operation, about 20 per cent suffer from severe and intractable forms of the disease and do not improve on medical treatment. Many of these persons die of the disease or are incapacitated, both economically and socially. Since colectomy rehabilitates these patients and prevents most of the fatal complications of the disease, serious consideration must be given to extending the indications for surgical intervention.

Prior to the development of the modern type of ileostomy appliance, the life of the patient who had undergone an ileostomy was not a pleasant one. The appliances were not leakproof, many were malodorous, and provision was not made for protecting the skin from the irritating discharges of the ileostomy. Moreover, the technic and postoperative management of ileostomy and of colectomy had not been developed, the mortality rate was high among surgical patients, and often the stomas were so placed that they could not be fitted with a satisfactory appliance. For these reasons, gastroenterologists in the past seldom advised ileostomy or colectomy for patients with ulcerative colitis.

Results of Simultaneous Ileostomy and Subtotal Colectomy in the Treatment of Chronic Ulcerative Colitis

In the past 5 years advances in the technic of ileostomy and colectomy and improvements in the preoperative and postoperative care of patients with ulcerative colitis have resulted in a striking reduction in both morbidity and mortality after operation. For example, in the past 2 years (September 1949 — September 1951) we have. . .


 

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