Depth of ulceration in acute colitis: correlation with outcome and clinical and radiologic features.

The depth of colonic ulceration has been graded histologically in 40 patients treated by urgent colectomy for acute colitis. Dilatation of the colon occurred in only 2 of 16 patients with ulceration limited to the submucosa, but in 18 of 24 patients with ulceration which extended into the muscle layer. Perforation occurred in 4 of the 6 patients in whom ulceration was seen to penetrate the muscle completely; the only two deaths occurred among these 4 patients. Complications of colitis thus correlated with the depth of ulceration. The clinical, laboratory, and radiologic features just before operation have been correlated with the depth of ulceration. While there was tendency for anorexia, abdominal tenderness on palpation, fever, tachycardia, leucocytosis, and hypoproteinemia to occur more commonly as the depth of ulceration increased, no single feature or combination of these features correlated well with ulcer depth. A colonic segment exceeding 5 cm in diameter with an irregular mucosal edge, outlined by gas on a plain abdominal radiograph, correlated strongly with ulceration involving the colonic muscle.