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Surgical management of ulcerative colitis

Phillip R Fleshner, MD, FACS
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


Ulcerative colitis is a chronic disease of the colon and rectum characterized by relapsing and remitting episodes of inflammation. Although ulcerative colitis is primarily treated medically, surgery may be required in patients who become refractory to medical therapy or develop severe complications [1,2].

This topic will review surgical management of patients with ulcerative colitis. Medical management of ulcerative colitis is discussed separately. (See "Management of severe ulcerative colitis in adults" and "Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults" and "Management of mild to moderate ulcerative colitis in adults" and "Approach to adults with steroid-refractory and steroid-dependent ulcerative colitis" and "Anti-tumor necrosis factor therapy in ulcerative colitis".)


Indications for emergency surgery — Patients with ulcerative colitis who develop one or more life-threatening complications require immediate surgery [3]. These complications include colonic perforation, life-threatening gastrointestinal hemorrhage, and toxic megacolon. (See "Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults", section on 'Disease severity'.)

Colonic perforation — Patients with ulcerative colitis who develop colonic perforation require colectomy, although this complication is rare.

Life-threatening gastrointestinal hemorrhage — Massive colorectal hemorrhage occurs in a small percent of patients with ulcerative colitis at some time during their disease course, which necessitates immediate surgery [3].

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Literature review current through: Nov 2017. | This topic last updated: Mar 13, 2017.
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