Ulcerative colitis is a condition in which the body's immune system attacks healthy tissue within the colon. This form of inflammatory bowel disease causes damage and small sores (called ulcers) to appear in the colon. Fulminating (or fulminant) ulcerative colitis is a severe form of the disease that can cause life-threatening complications.
Identification
Fulminant ulcerative colitis, according to the Merck Manual, is also known as toxic ulcerative colitis. Patients with this form of the disease have inflammation that has extended beyond the lining of the intestine (known as the mucosa) and instead have developed ulcers (sores) that extend all the way through the lining of the small intestine. This is considered to be one of the most severe forms of the disease.
Symptoms
Patients with fulminant ulcerative colitis, according to the Mayo Clinic, have sudden and severe pain in their abdomen. In most cases, fulminant ulcerative colitis occurs after a patient has had long-standing ulcerative colitis, so fulminant disease will usually manifest itself as a sudden exacerbation of the pain. Patients also often have acute and severe diarrhea, which can ultimately lead to dehydration. Any patient with ulcerative colitis who experiences a sudden worsening of symptoms should be evaluated for fulminant ulcerative colitis.
Complications
Fulminant ulcerative colitis, the Merck Manual explains, causes loss of muscle tone around the colon, sometimes within hours. This causes the colon to rapidly dilate and expand, which leads to a weakening of the colon's walls. If this happens, it puts the patient at risk of developing a rupture in the colon, which is a medical emergency. The colon is filled with bacteria, and if it ruptures, it can lead to bacteria spreading throughout the abdominal cavity, which can cause a life-threatening infection.
Diagnosis
Ulcerative colitis is a chronic condition, which means that most patients with fulminant disease will already be aware of their condition. Fulminant ulcerative colitis is diagnosed much like other forms of ulcerative colitis, with a sigmoidoscopy and biopsy. This test involves the insertion of a small flexible camera up through the colon, which allows physicians to visualize the colon's health and diagnose the extent of the damage. A biopsy of the tissue is often taken for further analysis, which allows a trained specialist to determine the depth of the ulcerations.
Treatment
Because fulminant ulcerative colitis is such a serious complication, it requires immediate medical treatment. Patients with this stage of the disease, according to the Penn State Milton S. Hershey Medical Center College of Medicine, usually need surgical treatment. The American Society of Colon and Rectal Surgeons explains that a proctocolectomy, in which the entire colon, rectum and anus is removed, not only removes the fulminant disease but also prevents future complications. This procedure does, however, require an ileostomy, in which the remaining intestine is routed out of the body through the abdominal wall. Alternatively, the diseased intestine can be removed, which allows the remaining intestine to be reattached to the rectum and anus.
