Ulcerative Colitis

What is Ulcerative Colitis

Ulcerative colitis is inflammatory condition of large bowel which starts from the rectum amd involves in a retrograde fashion the proximal large bowel. Rarely it involves the small bowel. The most common symptom is diarrhoea. The cause of ulcerative colitis is unknown. It has been postulated that it may be caused by interaction between patient genetic susceptibility and the environment. The course of the disease is characterized by period of exacerbation of symptoms and remission. The remission of symptoms may be spontaneous or may be due to medicine. Because of trasmural nature of disease it may lead to complications like abscess formation, fistula to orther organs and bowel stenosis. Long term ulcerative colitis is risk factor for bowel cancer. It is managed initally by Gastroenterologist.

Indications for Surgery in Ulcerative Colitis

Emergency Indications

  • Hemorrhage
  • Perforation
  • Toxic Megacolon
  • Fulminant disease activity not responsive to maximal medical therapy

Elective Indications

  • Complications of Medical therapy for ulcerative colitis
  • Frequent remission despite maximal medical therapy
  • Cancer/Intestinal Dysplasia
  • Growth retardation in children

Elective Indications

  • Complications of Medical therapy for ulcerative colitis
  • Frequent remission despite maximal medical therapy
  • Cancer/Intestinal Dysplasia
  • Growth retardation in children

Surgery for Ulcerative Colitis

Emergency surgery
Total abdominal colectomy with Hartman procedure or mucus fistula and end ileostomy is done
Elective Surgery
It can be done in one stage or two stage. Surgery done is total procto-colectomy in which whole of large bowel and rectum are removed. After that a pouch is created from distal part of ileum and this pouch is anastomosed to anal canal. The whole procedure is called as total procto-colectomy with ileo-anal pouch anastomeses.This can be done as a single time surgery. In high risk patients who are on steroids a diverting loop ileostomy is also created. In these patients ileostomy is closed after 4 weeks

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