Surgery in ulcerative colitis

Q: All of the following are indications for emergency surgery in ulcerative colitis except?

A) Colonic perforation
B), Life-threatening colorectal  bleeding
C) Toxic megacolon
D) Acute fulminant colitis if they fail medical therapy
E) All of the above


Answer: D

Surgical intervention for ulcerative colitis falls into three categories

1. emergency surgery
2. urgent surgery
3. elective surgery

Patients with colonic perforation, life-threatening gastrointestinal (GI) bleeding and toxic megacolon require emergency surgery.

Patients admitted to hospital who develop acute fulminant colitis  and do not respond to medical therapy are candidates for urgent surgery. Urgent surgery is defined as surgery on the same hospitalization.

Elective surgery should be decided on case to case basis as per indications for surgical guidelines from societies.



References: 

1.  Cima RR, Pemberton JH. Medical and surgical management of chronic ulcerative colitis. Arch Surg 2005; 140:300. 

2.  Andersson P, Söderholm JD. Surgery in ulcerative colitis: indication and timing. Dig Dis 2009; 27:335.