Colitis – Grade 3 or 4

Assessment and Investigations

  • Perform anamnesis
  • Physical examination
  • Blood analysis (H, S, CRP)
  • Coproculture
  • Perform CT-scan and rectosigmoidoscopy (if no risk of perforation)
  • Check CMV on bowel biopsy

Management escalation pathway

  • Consult with abdominal surgeon: consider laparotomy in case of bowel perforation
  • Consult ICU physician: manage shock
  • Manage dehydration, malnutrition and anemia according to standard practice.
  • Start Solumedrol 125 mg iv 1x/day for 3 consecutive days
  • Initiate oral antibiotics (e.g. ciproxin 250 mg BID) in case of suspected infectious origin and adapt according to result of coproculture