Benign and malignant colorectal strictures in ulcerative colitis.

Department of Medicine, Mount Sinai School of Medicine, City University of New York, NY.
Gut (Impact Factor: 13.32). 08/1992; 33(7):938-41. DOI: 10.1136/gut.33.7.938
Source: PubMed

ABSTRACT Colorectal strictures, either benign or malignant, are not uncommon in ulcerative colitis. Fifty nine of 1156 ulcerative colitis patients (5%) admitted to this hospital between 1959 and 1983 developed 70 separate colorectal strictures. Seventeen of the 70 strictures (24%) proved to be malignant and the other 53 benign. Nine patients developed more than one stricture. Three principal features distinguished the 17 malignant from the 53 benign strictures in this series: (1) appearance late in the course of ulcerative colitis (61% probability of malignancy in strictures that develop after 20 years of disease v 0% probability in those occurring before 10 years); (2) location proximal to the splenic flexure (86% probability of malignancy v 47% in sigmoid, 10% in rectum, and 0% in splenic flexure and descending colon); and (3) symptomatic large bowel obstruction (100% probability of malignancy v only 14% in the absence of obstruction or constipation). Moreover, cancer associated with strictures tends to be more advanced (76% stage D, 24% A and B) than that which does not produce strictures (18% stage D, 59% A and B).

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    ABSTRACT: Surgical therapy of ulcerative colitis is effective, safe, and provides an improved quality of life in those whose disease cannot be managed medically. In the elective setting, widespread acceptance of restorative proctocolectomy has made surgical therapy an attractive option in the overall management of ulcerative colitis. Enthusiasm for this procedure should be tempered by the acknowledgment of the significant incidence of pouchitis in the long term, however. Proctocolectomy with ileostomy remains a good surgical option for patients who are unsuitable for restorative procedures. The standard therapy for fulminant colitis or toxic megacolon remains subtotal colectomy with ileostomy. Patients undergoing subtotal colectomy are candidates for conversion to restorative procedures.
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    ABSTRACT: Intestinal obstruction and pseudo-obstruction represents a severe complication and a potential emergency in Crohn's disease and ulcerative colitis. Such intestinal complications are of great importance and may require urgent surgical management. This review discusses the clinical importance, the risk factors and the pathophysiological basis of this phe-nomenon. Diagnosis and imaging of obstruction together with common and rare causes of obstruction and pseudo-ob-struction including toxic megacolon are extensively reviewed. Non-surgical treatment of obstruction in inflammatory bow-el disease is reviewed including pharmacologic colonic de-compression and infliximab use. Endoscopy in pseudo-ob-struction, toxic megacolon, and in stenoses and strictures is reviewed and the setting of the optimal time for surgery in obstructing cases is provided. Strictureplasty or resection in stenoses, post-surgical obstructions as well as available prognostic markers of obstruction and pseudo-obstruction are critically revised.