Nonspecific ulcerative colitis - Complications

Perforation of the colon. One of the most severe complications of nonspecific ulcerative colitis, observed in 19% of patients with severe disease. Colon ulcers can perforate, multiple perforations of the overstretched and thinned colon against the background of its toxic dilation are also possible.

Perforations occur into the free abdominal cavity and may be covered.

The main symptoms of colon perforation are:

• the appearance of sudden sharp pain in the abdomen;
• the appearance of local or widespread tension in the muscles of the anterior abdominal wall;
• a sharp deterioration in the patient's condition and worsening of intoxication symptoms;
• detection of free gas in the abdominal cavity during plain fluoroscopy of the abdominal cavity;
• the appearance or increase of tachycardia;
• presence of toxic granularity of neutrophils;
• pronounced leukocytosis.

Peritonitis may develop without perforation due to transudation of intestinal contents through the thinned wall of the colon. The diagnosis of colon perforation and peritonitis can be clarified using laparoscopy.

Toxic dilatation of the colon. A very severe complication characterized by its excessive expansion. The development of this complication is facilitated by the narrowing of the distal sections of the colon, the involvement of the neuromuscular apparatus of the intestinal wall, smooth muscle cells of the intestine, loss of muscle tone, toxemia, ulceration of the intestinal mucosa.

The development of this complication can also be facilitated by glucocorticoids, anticholinergics, and laxatives.

The main symptoms of toxic dilatation of the colon are:

• increased abdominal pain;
• decrease in stool frequency (do not consider this a sign of improvement in the patient’s condition!);
• increasing symptoms of intoxication, lethargy of patients, confusion;
• increase in body temperature to 38-39°C;
• decreased tone of the anterior abdominal wall and palpation (palpate carefully!) of the sharply dilated large intestine;
• weakening or disappearance of intestinal peristaltic sounds;
• detection of distended areas of the colon during plain radiography of the abdominal cavity.

Toxic dilatation of the colon has an unfavorable prognosis. Mortality rate for this complication is 28-32%.

Intestinal bleeding. Blood in the stool with nonspecific ulcerative colitis is a constant manifestation of this disease. Intestinal bleeding as a complication of nonspecific ulcerative colitis should be discussed when blood clots are released from the rectum. The source of bleeding is:

• vasculitis at the bottom and edges of ulcers; this vasculitis is accompanied by fibrinoid necrosis of the vessel wall;
• phlebitis of the intestinal wall with expansion of the lumen of the veins of the mucous, submucosa and muscular membranes and ruptures of these vessels.

Strictures of the colon. This complication develops when nonspecific ulcerative colitis lasts more than 5 years. Strictures develop along a small section of the intestinal wall, affecting a section 2-3 cm long. Clinically, they manifest as intestinal obstruction of varying severity. Irrigoscopy and fibrocolonoscopy play an important role in diagnosing this complication.

Inflammatory polyps. This complication of nonspecific ulcerative colitis develops in 35-38% of patients. Irrigoscopy plays a major role in the diagnosis of inflammatory polyps, revealing multiple filling defects of regular shape along the colon. The diagnosis is verified by colonoscopy and biopsy with subsequent histological examination of biopsy specimens.

Colon cancer. Currently, the point of view has been formed that nonspecific ulcerative colitis is a precancerous disease. G. A. Grigorieva (1996) indicates that the greatest risk of developing colon cancer is in patients with total and subtotal forms of ulcerative colitis with a disease duration of at least 7 years, as well as patients with left-sided localization of the process in the colon and a disease duration of more than 15 years. The basis for diagnosis is colonoscopy with targeted multiple biopsy of the colon mucosa.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ]