This protocol applies to hospitalised patients with acute severe ulcerative colitis (ASUC) — defined as 6 or more bowel movements daily accompanied by at least one systemic sign of toxicity:
These patients have been treated with inpatient medical rescue therapy — intravenous infliximab or intravenous cyclosporine — but have not achieved the required clinical response by day 7: stool frequency has not decreased, rectal bleeding persists, and C-reactive protein has not fallen.
When medical rescue therapy does not produce the required response, management escalates to a surgical approach. The full structured protocol specifies the precise indications and the preferred surgical option for this situation.
DOI: 10.14309/ajg.0000000000003463
ASUC is defined as the presence of 6 or more bowel movements daily accompanied by at least one systemic sign of toxicity including tachycardia, fever, anemia (hemoglobin <10.5 g/dL), or elevated inflammatory markers (ESR >30 mm/hr).
Toxic megacolon, colonic perforation, severe refractory hemorrhage, and refractoriness to medical therapy are indications for surgery in patients with ASUC.
The preferred surgical treatment of choice is a subtotal or a total colectomy with end ileostomy.
View source ↗