Cyclosporin for severe ulcerative colitis does not increase the rate of perioperative complications

PURPOSE: Cyclosporin is used in severe ulcerative colitis that is refractor y to intravenous steroids. Cyclosporin is a potent immunosuppressant and ca n cause side effects such as opportunistic infections. This study aimed to investigate the incidence of perioperative complications in patients treate d with intravenous cyclosporin and steroids compared with patients treated with intravenous steroids atone. METHODS: We retrospectively reviewed the c ase notes of 44 patients with severe ulcerative colitis who underwent total abdominal colectomy and ileostomy. Twenty-five patients were treated with intravenous steroids and 19 patients were treated with intravenous cyclospo rin and steroids. Details were recorded with respect to age, length of illn ess, extent of disease, Truelove and Witt's criteria, hemoglobin and albumi n at surgery, surgical procedure, and perioperative morbidity. RESULTS: Twe nty-four percent of patients treated with intravenous steroids alone and 15 .8 percent of patients treated with intravenous cyclosporin and steroids ha d major surgical complications. Sixteen percent of patients treated with in travenous steroids atone and 5.2 percent of patients treated with intraveno us cyclosporin and steroids had minor surgical complications. Eight percent of patients treated with intravenous steroids alone and 10.5 percent of pa tients treated with intravenous cyclosporin and steroids had major medical complications. There was no mortality in either group. CONCLUSIONS: There i s no increased incidence of perioperative complications associated with the use of intravenous cyclosporin in addition to steroids in acute severe ulc erative colitis provided cyclosporin treatment is for a defined period and surgery is not delayed.