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Henry Ford Hospital Medical Journal

Abstract

Acute, toxic dilatation of the colon in granulomatous colitis occurs more frequently than heretofore reported, and is a more serious complication than its counterpart in ulcerative colitis. Twenty-six patients who had toxic megacolon were seen at the Henry Ford Hospital between 1961 and 1971. Fourteen of these had ulcerative colitis and 12 had granulomatous colitis. Coricosteroids were relatively ineffective in these 12 patients and all but two needed surgical intervention. Postoperative complications occurred in two cases, with two deaths. Although the initial clinical picture between the two conditions is identical, the clinical course In those with granulomatous colitis is more serious. The radiological picture is generally similar, but some differences were appreciated. Distension in granulomatous colitis was generally confined to the transverse colon with a noticeable lack of distension in the sigmoid segment. Inflammatory polyps were invariably present, and these tended to be more numerous and larger than those seen in distended colons in ulcerative colitis. In view of the more serious clinical course and ineffectiveness of medical management, early surgery is recommended in those patients with toxic distension of the colon complicating granulomatous colitis.

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