Hydrocortisone enemas, 5-ASA and sulfasalizine topically as enemas and suppositories are helpful and probably have little if any relationship to diving. Patients with heavy rectal bleeding often require blood transfusions to correct anemia. Parenteral hyperalimentation is sometimes used for nutritional support, but is of no value whatever as primary therapyand should not be allowed to delay definitive surgery. Dehydration, hypokalemia and anemia are all hazards to the diver. Decreased immune response is hazardous to the diver in the alien marine bacterial environment.
Toxic colitis is a grave emergency.
If intensive medical measures do not produce definite improvement within 24 to 48 h, immediate surgery is required or the patient may die from perforation and attendant sepsis. Emergency colectomy is indicated for massive hemorrhage, fulminating toxic colitis, or perforation. Subtotal colectomy with ileostomy and rectosigmoid mucous fistula is usually the procedure of choice, sincetotal proctocolectomy with abdominoperineal resection is more than most critically ill patients can tolerate. An ileostomy and a mucous fistula do not abrogate Boyle's Law and are not a risk for perforation. In any event, the intact rectal stumpshould not be allowed to remain indefinitely because of the risk of disease activation or subsequent malignant degeneration.