RECHERCHES SCIENTIFIQUES

FACTEURS PREDICTIFS DE MORBI-MORTALITE POSTOPERATOIRE DANS LES COLITES AIGUES GRAVES

Référence945
Année2015
TypeThèse
Lien document
AuteurSossey alaoui J
DisciplineChirurgie viscérale B
EncadrantToughrai I

Our work is a retrospective study on a serie of 65 cases of severe acute colitis, collected during a period of 06 years in visceral surgery services A and B, gastroenterology and intensive care unit A4 of the University Hospital Hassan II o Fez. The average age of our patients was 34 +/- 12.5 years, with extremes ranging from 14 to 65 years. The women predominated with a sex ratio F/M of 1.16. The severe acute colitis was inaugural in 40% of cases. The mean time to consultation was 20 days. The clinical and biological criteria of Truelove and Witts were adopted for the definition and admission of our patients. 12 cases of our patients occurred in; an array of complications (malnutrition, perforation, toxic megacolon with preperforation marks, massive bleeding, consciousness disorders, thrombophlebitis). The Endoscopy was performed in 93.9% of cases, it helped to highlight endoscopic signs of severity in 57.3% (35/61 cases). The non-specific treatment based on the hydro electrolytic rebalancing, diet, transfusion, heparin, antibiotics and steroid enemas. The Intravenous corticosteroid therapy was the first line of treatment in the majority of cases (62 patients). The second line medical treatment was initiated in 33.8% (21/62 cases). The surgery was indicated in 30 cases (46.2%) which 03 cases were operated immediately on admission. The subtotal colectomy with double stoma represented the type of surgery performed in almost all surgical patients (29 cases). In the univariate analysis, emergency surgery was labeled as a predictor of postoperative mortality, while female, complications at admission, fever, gravity signs in radiology, parenteral nutrition and preoperative hospitalization over than 03 days represented predictors of postoperative morbidity. In multivariate analysis, a complication on admission was the most implicated factor in postoperative morbidity, on the other side; emergency surgery and high level of CRP were the most incriminated factors in postoperative mortality. Remission was achieved globally in 54 cases (83%), while the mortality rate remains high (16.9%) compared to literature. After obtaining remission, 32 patients were put under maintenance therapy. Azathioprine was prescribed to 23 patients. The pathological result of the surgical specimen was about Ulcerative colitis in the majority of cases (23/30). The ileo-anal anastomosis with ileal pouch J-shaped was the type of restoration of continuity achieved in the majority of cases (19/22)