Postoperative mortality and complications after colectomy for ulcerative colitis.

During a 10-year period colectomy was performed on 101 patients. The postoperative mortality of 12 per cent was influenced decisively by duration and severity of the disease. Seventy-eight per cent of the patients were severly ill during the attack leading to colectomy, and 15 per cent of them died. One-third of the patients with toxic megacolon and general intoxication died. One-quarter of the patients with a history of less than 3 months died. The causes of death were peritonitis and pulmonary complications. Half of the patients developed postoperative complications of varying severity. Preoperative steroid medication did not influence the mortality or the postoperative complications. It is concluded that only close medical and surgical cooperation, careful selection of patients, and skillful timing of operations may reduce the mortality in ulcerative colitis. The paper supports that total colectomy in suitable cases may be performed without higher mortality than subtotal colectomy.

Toxic megacolon in ulcerative colitis.

During a 10-year period toxic megacolon occurred in 21 patients out of 296 with ulcerative colitis. The majority had a brief history, and half were over 40 years. A barium enema, which presumably may provoke dilatation of the colon, had been performed within the past week in 8 cases. The ulcerative colitis involved the entire colon in 85%, whereas the dilatation affected predominantly the transverse segment. Fourteen patients were on steroid medication when the dilatation developed. Operation was indicated in 20 patients (colectomy with ileostomy and preserved rectum). Six patients died postoperatively, half of pulmonary complications. Only one death occurred among 6 patients with perforation of the colon. Postoperative complications arose in 80%. Both complication rate and mortality were independent of steroid medication. Mortality was lowest among patients treated by a team of internists and surgeons specialized in gastroenterology. This was presumably due to an earlier recognition of the colonic dilatation, intensive medical treatment of severe attacks even before the dilatation had developed, and careful supervision for timing the operation, which should never be delayed in favour of attempts at steroid treatment.

Serum orosomucoid in ulcerative colitis: its relation to clinical activity, protein loss, and turnover of albumin and IgG.

Serum orosomucoid was compared with clinical activity, routine laboratory tests, intestinal protein loss, and albumin and IgG turnover in 22 cases of ulcerative colitis. Serum orosomucoid was well correlated with clinical activity, haemoglobin and leucocyte counts were not. A significant correlation was present between serum orosomucoid and intestinal protein loss (gastro-intestinal 59Fe-iron dextran clearance), serum albumin, fractional catabolic rates of albumin, and IgG and IgG synthesis rate. No correlation was found between serum orosomucoid and albumin synthesis rate or serum IgG. It is concluded that serum orosomucoid is a highly reliable indicator of disease activity in ulcerative colitis.