Course and prognosis of ulcerative colitis: Part III Complications

Abstract

Part III ComplicationsOne of the outstanding features of ulcerative colitis is the diversity of complications of the disease.They fall logically into two main groups: local complications in and around the large bowel, and remote or systemic complications affecting distant parts of the body.Some of these complications are so dangerous that they make a substantial contribution to the con- siderable fatality due to this disease.Tables XXIV and XXV show the incidence of the main complications divided between 'first attack' cases and 'relapses', and further subdivided accord- ing to whether the complication occurred during the first referred attack or during the period of sub- sequent follow-up.'The right-hand column shows the overall incidence of these complications in our total series of 624 patients.This incidence must be regarded as an underestimate for two distinct reasons.First, in many cases we have had to rely purely on the case notes for our information, and some of the complications, especially minor ex- amples, may not have been recorded in all instances.Secondly, it can be seen from Tables XXIV and XXV that these complications are numerous during the course of follow-up and therefore some patients who have so far escaped complications are almost certain to have one or more in the future. LOCAL COMPLICATIONSISCHIO-RECTAL OR PARARECTAL ABSCESS Ischiorectal abscess is a common complication, about one in 25 of our whole series having had one so far.Such an abscess may form at any time, either in a first attack or in a relapse of long-established disease.Sometimes the abscess may appear when the colitis is clinically quiescent, although sigmoidoscopy will reveal that the rectum and lower colon are inflamed.An ischio-rectal abscess demands surgical drainage without delay.The abscess is often deep-seated so that formal surgery is required.It is one of the few 'The Tables are numbered consecutively in Parts I to IV inclusive.complications which are amenable to conservative surgery, leaving the colon intact.Illustrative case history Mr. W. L. was first seen at this hospital in 1955, when he presented in his first attack of ulcerative colitis, at the age of 34 years.There was evidence of disease affecting the bowel from the trans- verse colon onwards, but the attack was mild, and he responded well to treatment with local hydrocortisone.Three months later, after a recurrence of symptoms, he developed a very large ischio-rectal abscess.This was opened and drained without any complications, and he made a satisfactory recovery.Since then, there has been no recurrence of symptoms.