The fulminant course of Crohn´s disease and ulcerative colitis is characterized by the sudden onset and fast progression to the septic condition. The major cause of the fulminant course is gradually increasing activity of inflammatory bowel disease. The fulminant course might be the first clinical manifestation of inflammatory bowel disease or gradually arises on the base of mild or moderate course of diseases. The incorrect investigation or therapeutical procedures and infections can induce in the fulminant course of inflammatory bowel disease in some patients. The severe complications of fulminant course occured relatively frequently. They included toxic megacolon, tromboembolism, massive bleeding and inflammatory intraabdominal infiltrates. The management of the fulminant course is based on the specific antiinflammatory therapy as well as in resucitation care including total parenteral nutrition. When medicament therapy failed, a surgical options are absolutely needed.