Dramatic Deep and Durable Remission of Acute Fulminant Ulcerative Colitis Achieved with Cyclosporine in a Patient Who Failed the Induction Intravenous Phase of Cyclosporine

Medical rescue therapy for patients with severe steroid-refractory ulcerative colitis (UC) consists of intravenous (IV) cyclosporine or infliximab and remains limited. Cyclosporine is used by fewer medical facilities due to comfort and need for close drug level monitoring, despite evidence that it can have dramatic benefits. In many tertiary centers it is accepted that after 3–7 days of treatment with IV cyclosporine without response, a patient will not respond to the therapy, and other modalities, namely surgery, should be considered. We present the case of a 36-year-old man with acute severe UC refractory to steroids and multiple biologics, who “failed” IV cyclosporine for 2 weeks, much longer than the usually accepted induction phase, and achieved remission with continuation of oral cyclosporine. This case demonstrates the possibility that continued therapy with cyclosporine for a longer duration than the currently accepted timeline can lead to remission and avoidance of colectomy in properly selected and monitored patients.

Role of Loop Ileostomy in the Management of Ulcerative Colitis Patients

Background: Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon.Loop ileostomy might be helpful in the management of the disease. Objective: To evaluate the role of loop ileostomy in the management of ulcerative colitis. Methods: Between Januarys 2008 and January 2018, patients with fulminant ulcerative colitis resistant to medical therapy had been referred to our surgical unit and were included in our study. Assessment of the patients’ medical status (serum electrolytes, total serum protein, complete blood count, erythrocyte sedimentation rate, general stool exam,and abdominal ultrasound and x-rays) and psychological statuswere done and then preoperative status correction followed by defunctioning loop ileostomy operated upon them and followed postoperatively in hospital for the response fortwo weeks of hospitalization. Results: Twenty patients were included in the study, two patients died postoperatively due to comorbidities and pulmonary embolism. Eighteen of twenty patients had a gradual improvement clinically (mucus diarrhea with/without blood, weight gain, fever, psychological and edema) and in hematological and biochemicalvalues (complete blood count, serum albumin protein, erythrocyte sedimentation rate and electrolytes) within two weeks. Conclusion: Defunctioning loop ileostomy is a simple,less morbidprocedure if compared to other medical treatments which can change the complication features of fulminant ulcerative colitis towards either continue in medical therapy or towards definitive curative surgery and cost effective as it decrease the need for expensive medications.