Ulcerative colitis: complications

Perforation of the large intestine. One of the most serious complications of nonspecific ulcerative colitis is observed in 19% of patients with severe disease. Perforate ulcers of the large intestine, multiple perforations of overgrown and thinned colon are also possible on the background of its toxic dilatation.

Perforations occur in the free abdominal cavity and can be covered.

The main symptoms of large intestine perforation are:

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

Peritonitis can develop without perforation due to the transudation of intestinal contents through the thin wall of the colon. To clarify the diagnosis of perforation of the colon and peritonitis, it is possible with the help of laparoscopy.

Toxic dilatation of the large intestine. Very serious complication, characterized by excessive expansion. Development of this complication is facilitated by narrowing of the distal parts of the colon, involvement of the intestinal wall of the neuromuscular apparatus, smooth muscle cells of the intestine, loss of muscle tone, toxemia, ulceration of the intestinal mucosa.

The development of this complication can also contribute to glucocorticoids, cholinolytics, laxatives.

The main symptoms of toxic dilatation of the colon are:

• increased pain in the abdomen;
• reduction in the frequency of the stool (do not consider this a sign of improving the patient's condition!);
• increased symptoms of intoxication, inhibition of patients, confusion;
• increase in body temperature to 38-39 ° C;
• decrease in the tone of the anterior abdominal wall and palpation (palpation carefully!) sharply enlarged large intestine;
• weakening or disappearance of peristaltic intestinal noise;
• the detection of bloated areas of the colon at the survey radiography of the abdominal cavity.

Toxic dilatation of the large intestine has an unfavorable prognosis. Mortality in this complication is 28-32%.

Intestinal bleeding. The admixture of blood in the feces with ulcerative colitis is a constant manifestation of this disease. About intestinal bleeding as a complication of nonspecific ulcerative colitis should be said, when blood from the rectum is secreted. The source of bleeding are:

• vasculitis on the bottom and edges of ulcers; these vasculitis are accompanied by fibrinoid necrosis of the vascular wall;
• phlebitis of the intestinal wall with widening of the lumen of the mucosa, submucosal and muscular membranes and ruptures of these vessels.

Colic strictures. This complication develops with the duration of the course of ulcerative colitis for more than 5 years. Strictures develop on a small length of the intestinal wall, affecting a segment 2-3 cm long. Clinically, they manifest a clinic of intestinal obstruction of varying degrees of severity. Irrigoscopy and fibrocolonoscopy play an important role in the diagnosis of this complication.

Inflammatory polyps. This complication of nonspecific ulcerative colitis develops in 35-38% of patients. Irrigoscopy plays an important role in the diagnosis of inflammatory polyps, with multiple defects filling the correct shape in the course of the colon. The diagnosis is verified using a colonoscopy and a biopsy followed by a histological examination of the biopsy specimens.

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

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