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

Hospitalize:

• 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