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Complicated form of ulcerative colitis - strategy and treatment - case report

Ralica Ruseva, Aleksandar Zlatarov, Nicola Kolev, Anton Tonev


Introduction: Ulcerative colitis is one of the inflammatory bowel diseases (IBD) and affects the colon and rectum. Typically it manifests as continuous areas of inflammation and ulceration. One of the features of the disease is the development of local and systemic complications. A very serious complication is the development of toxic megacolon with uncontrollable bleeding from the colon.

Materials and methods: A 43-year-old man was hospitalized in the clinic of Gastroenterology at St. Marina Hospital with bloody diarrhoea, abdominal pain and fever with a history of ulcerative colitis. Optical colonoscopy was performed and it showed a typical active ulcerative colitis. The early treatment algorithm started with antibiotics and methylprednisolone 40mg. For the accompanying symptoms, Salofalk 1g, Antispasmodics and Proton pump inhibitors were added. The conservative therapy had no effect over the condition and the continuing bleeding from the colon. Therefore a transfer to an intensive care unit was required.

Results: Due to the depletion of the conservative treatment measures for complicated ulcerative colitis and after stabilizing his vital signs the patient was operated on by a surgical team from First Clinic of Surgery. Laparoscopic proctocolectomy with ileostomy was performed. In the postoperative period there were clinical and radiological signs of a limited pelvic abscess, which was treated by percutaneous drainage and antibiotics. The patient was to be indicated for surgery for J pouch ileo-anal anastomosis during the second stage.

Conclusion: Complications of ulcerative colitis are serious and in some cases life-threatening. The latest studies have shown that laparoscopic proctocolectomy with a second-step J pouch ileo-anal anastomosis is standard in cases of complicated ulcerative colitis. It is important to know the disease and the right combination of conservative and surgical treatment to ensure disease control and a complete lifestyle.


ulcerative colitis; proctocolectomy; IBD



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