The aim of this paper is to define diagnostic criteria and treatment guidelines for acute colitis at first attack. This clinical syndrome begins with not-specific signs and symptoms (diarrhea, abdominal pain, fever, dehydration, weight loss and so on). In such cases a diagnosis of colitis was not previously made; the severity of the disease is widely variable and prognosis is not foreseeable before a correct etiologic diagnosis. Relaps of previously diagnosed inflammatory bowel diseases are ruled out. Early etiologic diagnosis is essential to program appropriate medical treatment and to avert the possible evolution to severe acute colitis. The Authors assess the value of several means for diagnosis and decision making (clinical features, stool examination, microbiologic and serologic findings, endoscopy, radiology, histologic findings and clinical course). Closed clinical monitoring in Intensive Care Unit of critically ill patients is recommended. A series of 43 patients operated on for persistently severe or complicated acute colitis since 1975 to 1988 is afterwards presented. Twenty-eight patients suffered from acute colitis at first attack, whereas 15 patients had relapses of chronic colitis. Significant differences between the two groups arose for the following parameters: age, operative mortality, rate of subsequent restoration of the intestinal continuity after urgent colectomy. Analysis of these data suggest a better clinical course for patients with severe acute colitis at first attack in comparison to patients affected from acute severe relapse of chronic colitis, provided the etiologic diagnosis is early and exact.
|Translated title of the contribution||Severe acute colitis at first attack: diagnostic methodology and treatment|
|Number of pages||7|
|Publication status||Published - 1989|
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