Clinical Evaluation of Indications of Emergency Surgery for Ulcerative Colitis

Six patients undergoing emergency surgery for ulcerative colitis were assigned to the colectomy group. Surgery was performed due to toxic megacolon (TMC) in 3 patients, severe bleeding in 2, and ineffectiveness for conservative treatment in one. A total of 6 patients, including 3 with TMC cured by conservative treatment alone and 3 with severe bleeding also cured conservatively (though surgery was considered), were assigned to the non-surgery group. A comparative study on the two groups gave the following conclusions. Patients requiring blood transfusion and those showing hepatic dysfunction during the course tended to require surgery. Emergency surgery should be considered for the patients with TMC showing dilatation of the small intestine as well as large quantities of small intestinal gas on plain X-ray films. Those showing an extensive mucosal defect in the sigmoid colon by endoscopy should be operated on immediately. Therefore it seemed useful to perform endoscopic examination up to the sigmoid colon positively for deciding on emergency surgery. It was also recommended that endoscopic observation should include the sigmoid colon even when it is performed only for a diagnostic purpose.