MANAGEMENT AND LONG-TERM OUTCOME OF SEVER E ACUTE INFLAMMATORY BOWEL-DISEASE

Severe acute inflammatory bowel disease (SAIBD) poses several challeng es to the clinician, who must recognize the severity of the flare, per form an accurate evaluation, and immediately select the most appropria te surgical and/or medical treatment. Once the diagnosis of inflammato ry colitis is established, the severity of the flare should be assesse d based on clinical and biochemical alterations that indirectly reflec t the colonic involvement and, above all, on radiological and endoscop ic visualization of the lesions. These investigations ensure identific ation of complications requiring emergency surgery (colonic perforatio n, colonic dilatation, severe bleeding). Patients without complication s can be treated medically, under close supervision, with corticostero id therapy (1 mg/kg/d), elimination of oral nutrition, and intravenous fluids and electrolytes. Surgery should be performed if this conserva tive approach fails; this is currently the most common situation in wh ich surgery is performed in SAIBD. A third situation that requires sur gery is occurrence of a relapse at discontinuation of the conservative treatment. Subtotal colectomy with ileostomy and sigmoidostomy is saf e in emergency situations, ensures rapid recovery of a satisfactory ge neral condition, supplies data of value for the etiologic diagnosis, a nd can be followed by any of the currently available techniques for re storing continuity: ileoanal anastomosis with reservoir (ulcerative co litis and indeterminate colitis) or ileorectal anastomosis (Crohn's di sease) according to the condition of the rectum and anus, Iu the long- term, 80% of surgically-treated patients recover an unchanged body ima ge and an acceptable to very satisfactory quality of life after an ile orectal or ileoanal anastomosis. Some patients, however, require a per manent ileostomy, particularly those with Crohn's disease diagnosed ei ther during the acute episode or later, sometimes after an ileoanal an astomosis procedure.