Author(s)

Hakima Abid^*, Fatima Babakhouya, Ihssane Mellouki, Mounia El Yousfi, Noureddine Aqodad, Dafr Allah Benajah, Adil Ibrahimi, Mohamed El Abkari

Hepatogastroenterology Department, Hassan II University Hospital of Fez, Univesity Sidi Mohamed Ben Abdellah, Fez, Morocco.

Background: Severe acute colitis is a common complication of inflammatory bowel disease (IBD). Their diagnosis is based on clinical, laboratory, endoscopic and radiological. The severe acute colitis is a medical and surgical emergency; its mortality is 1% to 3%. The management should be swift and coordinated, upon admission, between medical and surgical teams. Methods: This is a retrospective study in Gastroenterology Service at the University Hospital HASSAN II Fez, over a period of 10 years (2005-2015). We included all patients admitted for severe acute colitis; all the epidemiological, clinical, endoscopic, histological, and therapeutic monitoring of patients were collected. Results: We collected 123 patients. Their average age was 35 years (16 - 70). It was a female predominance (sex ratio F/M = 1.19). 54 patients were admitted for an inaugural severe acute colitis (43%), while 69 patients were known carriers of IBD (56%). All patients were admitted to an array of severe acute colitis according to the criteria of Truelove and Witts modified. 9 patients were operated urgently because there was the presence of complications (5 cases of perforation, 3 cases of massive rectal bleeding, and one patient with an abscess in the right iliac fossa). Corticosteroids intravenously was administered to 114 patients, 74 patients (64%) had remission. Patients who have not responded to corticosteroids IV (N = 40): 1) 12 patients received treatment with oral cyclosporine: the remission rate was 66%. 2) 8 patients were put under Infliximab: The response rate was 75%. 3) Patients who have not responded to a second-line treatment underwent subtotal colectomy with a dual stoma. 4) The surgery was indicated as a second-line treatment in 20 patients who all received a subtotal colectomy with double stoma; totalizing colectomy and ileoanale anastomosis ware made in 4 patients. The mortality rate is higher in our series (12%) mainly postoperatively; it is due to the delayed admission of patients, which promotes the development of complications. Conclusion: Acute Severe Ulcerative Colitis is a medical and surgical emergency that requires a multidisciplinary approach; medical treatment is the basis of initial treatment; but surgery must always be indicated at the right time avoiding increasing the death rate, this rate is important in our series.

Acute Severe Ulcerative Colitis, Infliximab, Cyclosporine, Colectomy

Abid, H. , Babakhouya, F. , Mellouki, I. , Yousfi, M. , Aqodad, N. , Benajah, D. , Ibrahimi, A. and Abkari, M. (2018) Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases. Open Journal of Gastroenterology, 8, 107-117. doi: 10.4236/ojgas.2018.83012.