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May 1963

Fulminating Ulcerative Colitis With Colonic Wall Necrosis

Author Affiliations

Present address: University of Texas, M. D. Anderson Hospital, Houston (Dr. Hickey).; From the departments of surgery and pathology, College of Medicine, State University of Iowa.

Arch Surg. 1963;86(5):764-771. doi:10.1001/archsurg.1963.01310110074011

Chronic ulcerative colitis is a disease of protean manifestations involving many anatomical systems but with the distinguishing features of colonic inflammatory mucosal ulceration, fibrosis of the bowel wall, and relative uninvolvement of the colonic serosal surfaces. Of the many complications of ulcerative colitis, there are a group of catastrophic conditions occurring within the colon, namely, perforation, massive bleeding, and carcinoma.1 To these obstruction might well be added, although it overlaps with the complications named, for the obstruction may be neoplastic, cicatricial, or it may be adynamic. This latter occurs in fulminating attacks, dangerous especially because dilation tends to accentuate colonic wall necrosis and thus leads to perforation and peritonitis. This report is directed to a review of actual colonic wall perforation or threatened colonic wall necrosis in 13 ulcerative colitis patients at the State University of Iowa Hospitals, 11 in fulminant attacks and 2 with acute focal perforations.