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Inflammatory Bowel Disease Emergencies: Toward Faster Identification & Management

Some of the most severe complications associated with ulcerative colitis are toxic megacolon, bleeding, fulminant colitis, and perforation of the bowel, while abscesses, intestinal bleeding, fistulas are more commonly associated with Crohn’s disease. While the development of emergency complications in IBD is uncommon, it can be life-threatening and result in permanent organ damage.

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Articles of Interest

Acute surgical emergencies in inflammatory bowel disease

Acute surgical emergencies in patients with inflammatory bowel disease are rare and can have a high morbidity. With a multidisciplinary approach, morbidity can be reduced and patients can have a rapid return and improved quality of life.

Diagnostics: Inflammatory Bowel Disease

Intestinal complications of IBD

EM@3AM: Inflammatory Bowel Disease

The presentation of an IBD flare can range from a stable patient with worsening of typical symptoms to a patient in extremis with severe hypovolemic or septic shock.

Inflammatory Bowel Disease in the Emergency Department

Patients with IBD frequently present to the emergency department for the treatment of flares. It is the role of the emergency physician to resuscitate and restore fluid and electrolyte balance, evaluate and control pain/fever/nausea, and to identify manifestations of IBD requiring urgent and emergent intervention (obstruction, intra-abdominal abscess and fistula formation, life-threatening hemorrhage, and toxic megacolon).

Management of Inflammatory Bowel Disease Flares in the Emergency Department

Because of the chronic relapsing nature of inflammatory bowel disease (IBD), emergency clinicians frequently manage patients with acute flares and complications. IBD patients present with an often-broad range of nonspecific signs and symptoms, and it is essential to differentiate a mild flare from a life-threatening intra-abdominal process.

Pediatric Inflammatory Bowel Disease In The Emergency Department: Managing Flares And Long-Term Complications

Children are more likely than adults to present with extraintestinal manifestations of inflammatory bowel disease (with aphthous ulcers, joint involvement, and growth delay being the most common). Inflammatory bowel disease flares typically require treatment with intravenous steroids and inpatient admission. Acute emergencies include toxic megacolon, intestinal obstruction, and perforation. The use of steroids may obscure diagnosis of an underlying abdominal emergency by masking signs and symptom.