389 Primary Resection in Acute Fulminating Ulcerative Colitis

I. Introduction Acute fulminating ulcerative colitis may develop spontaneously in apparently healthy individuals, or it may occur in patients with known chronic ulcerative colitis. The disease may progress rapidly and reach its peak in two to three weeks or continue for weeks or months with exacerbations and remissions. Certain cases, however, are irreversible with current medical management and terminate either in perforation of the colon or in a syndrome known as "toxic megacolon" (Fig 1).7This is characterized by abdominal distention, fever, diarrhea, and pain, and will frequently progress to perforation of the colon.5Careful, intensive medical management will control the disease in some individuals, but it is impossible to predict success or failure.6These patients present difficult problems and frequently require primary colectomy. The purpose of this paper is to present our experience with 14 patients with acute fulminating ulcerative colitis who were treated by primary