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Complications
Life-threatening complications can result from ulcerative colitis. These include toxic megacolon, colonic perforation, strictures, and a liver disorder called primary sclerosing cholangitis.
 
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Crohn's and Colitis Foundation of America: This nonprofit, volunteer-driven organization offers a wealth of information about living with UC, including physician listings and clinical trial information. |
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MedlinePlus--Ulcerative Colitis: A service of the U.S. National Library of Medicine and the National Institutes of Health, MedlinePlus includes a wide range of links offering overviews, discussing diagnosis/symptoms, treatment and research. Also see the interactive tutorial.
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American Gastroenterological Association--Inflammatory Bowel Disease: IBD refers to both UC and Crohn's disease, and this page covers possible causes, symptoms, and treatment. |
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NDDIC--Ulcerative Colitis: From the National Digestive Diseases Information Clearinghouse, this lengthy page explains UC and its treatment. |
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Cedars-Sinai--Ulcerative Colitis: This page from the top California hospital discusses symptoms, possible causes,risk factors, diagnosis, and treatment. |
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Ulcerative Colitis-Related Clinical Trials Information |
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Toxic megacolon:The most feared complication from severe ulcerative colitis is toxic megacolon. This condition occurs as a result of extension of the inflammation beyond the submucosa of the colon into the smooth muscle layer in the wall of the colon. This causes the colon to lose its ability to contract, ultimately resulting in a dilated colon, fever, weakness, racing heart, an abnormally elevated white cell count, abdominal tenderness, and other signs of toxicity. X-rays of the abdomen are done to diagnose the condition. Colonic perforation, or a hole in the wall of the colon, is a common complication with toxic megacolon, leading to peritonitis, and possibly death.
Medical therapy to reduce the likelihood of perforation of the colon wall and to return the colon to normal motor activity is the first step in treating toxic megacolon. Because patients should take nothing by mouth, a nasogastric tube is placed in the stomach for suction and decompression of the gastrointestinal tract. The use of a rolling technique during which the patient lies on his abdomen for 10 to 15 minutes every two hours while awake, allows gas to pass and the dilated colon to decompress. Intravenous fluids are given. Broad-spectrum antibiotics are begun in anticipation of possible peritonitis from a perforation. Intravenous steroids to reduce inflammation are usually administered. The patient's condition is closely monitored for signs of deterioration.
If the patient does not show signs of improvement during the first 24 to 48 hours of drug therapy, the risk of perforation increases markedly and surgical intervention is undertaken. Removal of the colon takes place in about 25 percent of patients who suffer toxic megacolon, and some 50 percent of patients with pancolitis (colitis affecting the entire colon). If surgery is performed before there is colonic perforation, the mortality rate is only about 2 percent. But in cases where there has been bowel perforation, the rate increases to 44 percent.
Perforation: Perforations can also occur in severe ulcerative colitis even if toxic megacolon does not develop. Most perforations occur in the left colon, commonly in the sigmoid colon. Perforations tend to occur more often during first episodes of colitis. Perforations must be treated surgically.
Strictures: Though uncommon in ulcerative colitis, strictures, or narrowings of the colon, are evident in about 12 percent of surgically removed colons. Strictures tend to occur late in the disease, usually 10 to 20 years after onset. The most common symptom is fecal incontinence. Strictures have been associated with colon cancer, and biopsy of the stricture is warranted.
Primary sclerosing cholangitis: This is a chronic liver disease in which the flow of bile in the liver is interrupted by fibrous tissue in the bile ducts. The abnormal tissue forms as a result of chronic inflammation. The condition is frequently associated with ulcerative colitis. People with this complication have symptoms of fatigue, abdominal pain, fever, or jaundice. It usually appears in men after 10 or 15 years of very mild, even subclinical pancolitis. The disease can become so severe it may necessitate liver transplant in some patients.
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