DILATATION OF THE COLON COMPLICATING ACUTE SELF-LIMITED COLITIS

Colonic dilatation has been reported as an occasional complication of infectious colitis in single case reports and short series, but no lar ge series has been published. We analysed 19 cases of self-limited col itis complicated by colonic dilatation, with infective agents identifi ed in 14, admitted to a Regional Infectious Diseases Unit. Colonic dil atation, defined as a minimum transverse colonic diameter of 7 cm on p lain abdominal X-ray, was associated with approximately 1% of cases of notifiable diarrhoea requiring hospital admission. The clinical cours e was associated with pyrexia (in 90%), tachycardia (in 90%), hypoalbu minaemia (in 100%), anaemia (in 84%) and reactive thrombocytosis (in 6 3%). There was a history of antidiarrhoeal agents or opiate analgesia in eighteen patients (95%). Intensive medical management, consisting o f intravenous antibiotics, steroids, supplementary nutrition and withd rawal of antimotility agents, resulted in resolution in 17 patients. T wo patients required subtotal colectomy for perforation of the transve rse colon, but neither developed severe peritonitis, and both subseque ntly underwent reversal of ileostomy. With early recognition and close observation of colonic dilatation in patients with acute diarrhoea, m ost cases can be successfully managed conservatively with preservation of the colon. Surgical intervention should be considered in patients with progressive colonic dilatation despite intensive medical manageme nt. There were no clinically useful parameters distinguishing self-lim ited colitis from inflammatory bowel disease acutely, so initial manag ement should cover both possibilities.