Severe complications can arise in patients with ulcerative colitis during acute exacerbations of the disease, or as the disease progresses.
Toxic megacolon, an acute form of colon distention, is rare in children, but when it does occur, it is a medical and surgical emergency. Toxic megacolon is thought to be caused when overwhelming inflammation interferes with motility. The ensuing bacterial buildup leads to necrosis and peritonitis.
Children diagnosed with UC have an increased risk for colonic malignancy as they get older. The earlier the onset of the disease, the greater the eventual risk for malignancy:
- The onset of UC before the age of 14 is associated with a 40 percent incidence of a colonic malignancy by the age of 35
- The onset between ages 15 and 39 is associated with a 30 percent incidence of a colonic malignancy by the age of 35
Because of this strong association, children who have been diagnosed with UC should be scheduled for yearly screenings with surveillance colonoscopy, and a biopsy should be performed to identify any precursor evidence of epithelial dysplasia.