Complications of ulcerative colitis

Complications of UC are divided into local and general (systemic). Local ones include perforation, toxic dilatation (toxic megacolon), intestinal bleeding, strictures of the rectum or colon, paraproctitis , fistulas, fissures , perianal skin irritation and colon cancer.

Systemic complications are associated with extraintestinal manifestations of ulcerative colitis.

You can read about the causes, diagnosis and types of ulcerative colitis in the article Ulcerative colitis .
Read about treatment methods for UC here .

Perforation

Perforation of the intestinal wall occurs when it expands and thins. The opening is usually located in the sigmoid colon or in the area of ​​the splenic flexure.

More often, perforations are multiple and penetrate into the abdominal cavity, less often they are single and covered. In new-onset ulcerative colitis, the incidence of perforation does not exceed 4%. Severe, long-term UC is complicated by perforation in approximately 10% of cases.

Diagnosis of this complication is quite difficult, since it causes a serious condition for the patient, and it is not always possible to obtain information from him about the symptoms that bother him. The results of a physical examination are also insufficiently informative (perforation is characterized by symptoms of peritoneal irritation).

An X-ray examination helps to establish the diagnosis of intestinal perforation, in which free gas is detected in the abdominal area.

Toxic dilatation (toxic megacolon) of the colon

This is a severe complication of UC, which develops in 5-10% of cases.

Lead to the development of toxic dilatation

• damage to the neurointestinal apparatus of the intestine,
• inflammatory damage to the smooth muscles of the intestinal wall,
• hypokalemia with impaired muscle tone,
• infection ( salmonellosis , shigellosis, yersiniosis etc.),
• ulceration,
• toxemia,
• diagnostic procedures (x-ray examination, colonoscopy),
• irrational drug therapy (prescription of opioids, anticholinergics).

Some researchers note the influence of steroid therapy and cholinergic drugs on the development of this syndrome.

Toxic megacolon is a paralysis of the smooth muscle muscles of the intestines that develops due to a severe inflammatory process. It is often the result of the thoughtless prescription of drugs that reduce intestinal motility (codeine, loperamide, anticholinergics and other drugs) for the treatment of diarrhea in acute ulcerative colitis, which can provoke toxic distension of the colon.

Just like the use of laxatives in the presence of constipation in patients with ulcerative colitis, especially against the background of hypokalemia, may cause the appearance of signs of toxic megacolon.

Toxic megacolon of the colon appears

• a sharp deterioration in the patient's condition,
• increasing intoxication,
• inhibition of reactions,
• an increase in body temperature of more than 38.8⁰С,
• decreased stool frequency,
• enlargement of the abdomen,
• weakening of peristaltic bowel sounds,
• flatulence,
• slight tension in the muscles of the anterior abdominal wall,
• tachycardia more than 120 beats/min.,
• leukocytosis over 10.6x10⁹/l,
• anemia.

The most important method in diagnosing this complication is a plain X-ray examination of the abdominal wall. It is performed with the patient lying on his back. A characteristic radiological sign of this complication is a significant expansion of the colon from 5 to 16 cm, with an average of 9 cm.

As a rule, the transverse colon is subject to the greatest expansion. And in approximately 50% of cases it is eliminated by surgery. The rectum does not undergo expansion.

The prognosis for this complication is very serious, especially when toxic dilatation and perforation of the colon occur simultaneously.

Conservative therapy for toxic megacolon is usually carried out within 24 hours.

The patient is transferred to parenteral nutrition .

All drugs administered orally (by mouth) are discontinued.

The goal of conservative therapy is to correct water and electrolyte balance, protein deficiency and anemia. Antibiotics and glucocorticoids in loading doses must be prescribed. It is necessary to constantly monitor the patient's condition. Monitoring diuresis is mandatory. It is important to carry out ultrasound and x-ray monitoring of the condition of the dilated colon.

If a patient with severe ulcerative colitis fails to achieve positive dynamics within 2-3 days, then he is indicated for urgent surgery.

Intestinal bleeding

Bleeding as a complication of UC must be distinguished from the discharge of scarlet blood in the feces during the normal course of ulcerative colitis.

With this complication, blood from the anus is released in clots. Massive bleeding in ulcerative colitis develops in no more than 1% of patients. The causes of intestinal bleeding may be the growth of granulation tissue at the bottom of the ulcer, vasculitis of the bottom and edges of the ulcers.

These changes are accompanied by necrosis of the vascular wall, phlebitis, leading to a sharp narrowing of the veins of the mucous, submucosal and muscular membranes of the intestine, expansion of their lumen with the formation of vessels resembling wide lacunae or cavernous-type vessels, which undergo rupture and cause massive bleeding.

Surgical treatment is necessary for a patient with intestinal bleeding if the injection of blood in a volume exceeding 3000 ml within 24 hours is required to stabilize the patient's condition.

Strictures of the rectum or colon

Found in approximately 10% of patients with ulcerative colitis. In a third of patients, the obstruction is localized in the rectum. In the presence of colonic strictures, there is always a need for a differential diagnosis with colon cancer or Crohn's disease .

Inflammatory polyps of the colon

Polyps are diagnosed by endoscopic and x-ray examination. A characteristic sign of this complication, detected during irrigoscopy, is the presence of multiple filling defects along the intestinal wall. The diagnosis of pseudopolyposis is confirmed histologically.

Systemic complications

Systemic complications are those that affect various human systems and organs. They occur in a significant proportion of patients with severe UC. Most complications are of an autoimmune nature and are an indicator of the activity of the pathological process. These complications of ulcerative colitis are divided into two groups: colitis-related and colitis-independent.

Extraintestinal complications of UC

In ulcerative colitis, both intestinal and extraintestinal diseases can occur. It is necessary to be aware of possible symptoms that at first glance are not related to the intestines. This will allow you to be alert, undergo an examination and diagnose serious intestinal inflammation as early as possible.

Such manifestations of the disease occur in 30% of patients suffering from UC. There is a certain relationship between extraintestinal manifestations, the extent of damage to the colon and the severity of the disease.

Lesions of the organ of vision

Eye diseases occur in 13-30% of cases.

Possible diseases:

• episcleritis;
• uveitis;
• retrobulbar neuritis;
• iridocyclitis;
• keratitis;
• retinal arteritis obliterans.

Of these diseases, uveitis is the most common. Moreover, ocular symptoms are often detected many years before the intestinal symptoms of ulcerative colitis appear.

Exacerbation of eye diseases develops against the background of severe exacerbations of ulcerative colitis and can even lead to blindness. Moreover, eye pathology can persist during periods of remission of the underlying disease.

Symptoms of eye damage:

• prolonged redness of the eye;
• pupil deformation;
• the appearance of “flies” before the eyes,
• deterioration of visual acuity,
• the appearance of flashes and flickering before the eyes,
• the shape of objects is distorted,
• vision becomes blurred
• difficulty reading,
• deterioration of twilight vision, impaired color perception.

Skin manifestations and lesions of the oral mucosa

These complications occur in 15% of people with ulcerative colitis and their course is directly related to exacerbations of this disease.

This type of complications is manifested by the following diseases:

• erythema nodosum;
• necrotizing pyoderma;
• aphthous stomatitis;
• gingivitis;
• ulceration of the lower extremities (erythema multiforme);
• psoriasis.

Stomatitis

Damage to the oral mucosa is more common in patients

• with anemia,
• with underweight,
• with vitamin deficiency.

This disease is relatively common in UC. Progression of the disease can lead to the development of gangrenous stomatitis.

Erythema nodosum

This complication is often combined with arthritis (chronic inflammation of the joints) and is quite often the first manifestation of ulcerative colitis.

Erythema nodosum manifests itself with symptoms such as:

• the appearance of dense nodes of different diameters from 5 mm to 5 cm,
• over the nodes the skin is red and smooth,
• the nodes rise slightly above the general skin, but no clear boundaries are observed,
• the tissues around the nodes swell,
• the nodes grow very quickly, but, having increased to a certain size, they stop growing,
• pain on palpation,
• after 3-5 days the nodes change color, the skin becomes brownish, then turns blue and gradually turns yellow,
• nodes often appear on the front surface of the legs,
• Most often the disease begins acutely, with fever.

Pyoderma gangrenosum

The skin is affected during severe disease, most often on the legs and in the sternum area. The appearance of this complication allows us to draw conclusions about the development of sepsis (blood poisoning).

Other skin complications

Recently, complications of UC have been described, such as

• focal dermatitis,
• boils,
• superficial skin abscesses,
• skin ulcerations,
• skin rashes (macular, papular, pustular, urticarial).

Lesions of the joints and spine

These complications occur in 20-60% of patients with ulcerative colitis. They appear more often in the chronic form of the disease.

Diagnoses that may be a consequence of ulcerative colitis:

• osteopathy;
• peripheral arthritis;
• ankylosing spondylitis;
• arthralgia;
• sacroiliitis.

Joint pain

Arthritis (joint disease) occurs equally often in both adults and children, in both men and women. In ulcerative colitis, the joints of the upper extremities and small joints are most often affected; in Crohn's disease, the knee and ankle joints are most often affected.

This complication occurs, as a rule, with significant damage to the colon. Exacerbations of the disease in 60-70% of cases are associated with exacerbations of UC.

The main symptoms are:

• swelling of the joints;
• soreness;
• redness of the skin over the joints;
• effusion into the synovial cavity.

With each exacerbation, as a rule, no more than three joints are affected. Moreover, different joints may suffer from attack to attack.

Backache

Ankylosing spondylitis is often combined with peripheral arthritis, uveitis and psoriasis.

The main symptoms of spondylitis are:

• backache;
• immobility of the spine;
• improvement in movement and exercise.

The disease can progress even during remission of ulcerative colitis and often leads to disability.

Liver lesions

Ulcerative colitis is often accompanied by diseases such as:

• fatty liver hepatosis;
• liver abscess;
• gallstones;
• sclerosing cholangitis.

Fatty liver hepatosis

In terms of frequency, fatty liver hepatosis ranks first. The process does not progress and there is no tendency to transform it into cirrhosis of the liver. Strict adherence to the diet, normalization of body weight, normal levels of protein, vitamins and microelements in the blood significantly improves the patient’s condition and has a positive effect on the course of the disease.

With this complication, you should be especially careful about the administration and duration of parenteral nutrition, since the soluble amino acids administered can have a toxic effect on the liver.

Sclerosing cholangitis

One of the most dangerous complications of UC. Hereditary and immunological factors are of great importance in its development.

It is characterized by inflammatory fibrosis, strictures of the extrahepatic and intrahepatic bile ducts, and may be accompanied by pancreatitis. This pathology occurs more often in young men and is manifested by the following symptoms:

• skin itching;
• fever;
• pain in the right hypochondrium.

Gallstones

Gallstone disease develops in ulcerative colitis as a consequence of impaired absorption of bile acids in the jejunum due to chronic diarrhea.

Urolithiasis disease

The severity of the disease is directly related to the extent of damage to the jejunum. With diarrhea, bile acids and calcium bind, and dietary oxalates remain in the intestinal lumen and are intensively absorbed with increased permeability of the intestinal mucosa.

Changes in the blood

As a rule, with ulcerative colitis, iron deficiency anemia, B₁₂-deficiency anemia, and autoimmune hemolytic anemia develop.

With UC, the risk of developing phlebothrombosis increases. The reason for this is the high level of fibrinogen in the acute phase of the disease and the low concentration of antithrombin.

External factors that provoke this complication include hydration, bed rest, and parenteral nutrition.

Thrombosis of the hepatic veins and pulmonary embolism may occur, which can be the cause of death in inflammatory bowel diseases.

Rare extraintestinal complications in ulcerative colitis

In medical practice, relatively rare cases of diseases have been noted, the development of which is also directly related to ulcerative colitis:

• bronchopulmonary diseases (pulmonary fibrosis, bronchitis, bronchiectasis),
• heart diseases (myocarditis, pericarditis, septic endocarditis).

With the development of these diseases and the ineffectiveness of their treatment, an examination of the gastrointestinal tract should be carried out, since if they are complications of its inflammation, then without complex therapy it is impossible to achieve a good result.