Ulcerative colitis-related severe enteritis: an infrequent but serious complication after colectomy

Atsushi Kohyama, Kazuhiro Watanabe, Akira Sugita, Kitaro Futami, Hiroki Ikeuchi, Ken ichi Takahashi, Yasuo Suzuki, Kouhei Fukushima

研究成果: Article査読

抄録

Background and aim: After colectomy for ulcerative colitis (UC), very severe and sometimes lethal enteritis can develop. However, the clinical features remain uncertain because of the low incidence, diversity of symptoms, and undefined diagnostic criteria. The aim of this study was to define postoperative ulcerative colitis-related severe enteritis (UCRSE) and to investigate its clinical features. Methods: A retrospective multicenter study was performed as a survey of major medical facilities utilizing surgical supplies for inflammatory bowel disease in Japan from 2001 to 2014. UCRSE was defined as a case with massive intestinal bleeding, intestinal perforation, high-output stoma, and/or a requirement for medications, such as steroids and biologics. Patients with gastroduodenal lesions or pouchitis alone were excluded. The incidence, symptoms, involvement of bacteria, cytomegalovirus reactivation, treatment, and prognosis were examined for patients with UCRSE after colectomy. Results: Forty-two (0.8%) out of 5284 cases met the criteria for UCRSE. Major symptoms were massive intestinal bleeding (76.2%), which required a median of 3850 (560–18900) mL blood transfusion; high-output stoma (38.1%) with excretion of fluid of 5000 (2000–7800) mL/day; and intestinal perforation (7.1%). Hypovolemic shock (35.7%) and/or disseminated intravascular coagulation (31.0%) developed as serious complications. Tests for cytomegalovirus reactivation were positive in 26.2% of cases. The presence of pathogenic bacteria was confirmed in only 5 cases. Corticosteroids or infliximabs were effective in half of the patients. Thirteen cases (31.0%) were treated surgically and 22 cases (56.4%) required maintenance therapy. The mortality rate was 11.9%. Conclusion: UCRSE is a rare but serious complication after colectomy and is sometimes life-threatening.

本文言語English
ページ(範囲)240-249
ページ数10
ジャーナルJournal of gastroenterology
56
3
DOI
出版ステータスPublished - 2021 3

ASJC Scopus subject areas

  • 消化器病学

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