In patients with inflammatory bowel disease (IBD) complications of both IBD and immunosuppressive therapy may be life-threatening conditions requiring intensive care therapy. These patients oftentimes present themselves with severe bloody diarrhoea, and infectious colitis, pseudomembranous colitis or intestinal ischemia must be included in the differential diagnosis. Steroids, immunosuppressants such as azathioprine, 6-mercaptopurine, methotraxate or ciclosporine, as well as biologicals, which act as TNF-alpha antagonists, are commonly used for maintenance therapy and treatment of acute exacerbations of IBD. Due to immunosuppressive therapy potentially life-threatening infections and reactivations of latent infections like tuberculosis or cytomegalovirus (CMV) can occur. Fistulas, abscesses, perforations and intestinal obstructions are typical complications of Crohn's disease in the intensive care setting, whereas clinical presentation in ulcerative colitis is characterised by its acute exacerbation and the toxic dilatation of the colon, potentially resulting in toxic megacolon with high risk of perforation or severe bleeding. Most important for an effective therapy in the critically ill patient with inflammatory bowel disease are the control of the underlying disease, the empiric antibiotic therapy in case of infectious complications, transcutaneous drainage of abscesses, bowel decompression in toxic megacolon and the early interdisciplinary assessment of the abdomen.
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