Inflammatory Bowel disease

• Inflammatory Bowel Disease

  Includes Ulcerative Colitis and Crohn's Disease
• Surgical Treatment of Ulcerative Colitis


  • Indications for surgery
  • Intractability
  • Dysplasia-carcinoma
  • Massive colonic bleeding
  • Toxic megacolon
• Intractability


  Colitis that is refractory to medical management, with fulminant colitis symptoms and no improvement after 4 days of treatment
• Patients' quality of life is improved after surgery for ulcerative colitis, regardless of the procedure performed
• Complications of long-term steroid therapy


  • Diabetes mellitus
  • Avascular necrosis of the femoral head
  • Cataracts
  • Psychiatric problems
  • Osteoporosis
  • Weight gain
• Dysplasia-carcinoma


  High-grade dysplasia is an absolute indication for colectomy, confirmed by two pathologists. Prevents, suspects, and treats carcinoma.
• Massive colonic bleeding


  Rare indication, most patients respond to conservative management. Less than 5% need urgent colectomies. Requires resuscitation and subtotal colectomy.
• Toxic megacolon


  Acute colitis with significant colon dilation that may lead to perforation. Requires subtotal colectomy with ileostomy, followed by proctectomy and ileal pouch-anal anastomosis.
• Acute disease conditions requiring subtotal colectomy and ileostomy


  • Perforation of the colon
  • Toxic megacolon
  • Haemorrhage
  • Refractory fulminant colitis
• Chronic disease conditions in ulcerative colitis


  • Frequent exacerbations
  • Chronic continuous symptoms
  • Malnutrition
  • Weakness
  • Inability to work
  • Incapacity to enjoy social and sexual life
  • Inability to discontinue corticosteroids
  • Severe extracolonic manifestations (arthritis, pyoderma gangrenosum)
• Total proctocolectomy and ileal pouch-anal anastomosis


  The gold standard operative treatment for most patients with ulcerative colitis. Removes the colon and rectum while sparing the anal sphincter, creating a pouch from the distal ileum.
• Complications of total proctocolectomy with ileal pouch-anal anastomosis


  • Small bowel obstruction
  • Pelvic sepsis-anastomotic leaks
  • Pouch-vaginal fistula
  • Pouchitis (inflammation of the ileal pouch mucosa)
• Total proctocolectomy with end ileostomy


  Removes all diseased mucosa, resulting in a cure. Patient has a permanent ileostomy. Indicated in the elderly, those with poor sphincter function, and patients with distal rectal cancer.
• Crohn's Disease


  • Duodenal disease
  • Ileitis
  • Perianal
  • Crohn's colitis
• The majority of patients with chronic Crohn's disease will need surgery at some point during the course of their illness
• Indications for surgery in Crohn's colitis

  • Intractability
  • Intestinal obstruction
  • Intra-abdominal abscess
  • Fistulas
  • Fulminant colitis
  • Toxic megacolon and perforation
  • Massive bleeding
  • Cancer
  • Growth retardation
• Operative treatment in Crohn's disease

  Relieve symptoms when medical management has failed, and correct complications to prevent cancer development. However, it may not cure the patient as Crohn's is a pan-gastrointestinal disease.
• Intractability in Crohn's disease

  The most common indication for operative treatment, involving failure of optimal medical therapy. The principle is to resect only enough intestine to improve symptoms or correct complications, to avoid short bowel syndrome.