Ulcerative colitis is a form of inflammatory bowel disease typically diagnosed in the 2nd or 3rd decade of life, though there is a subset of patients that can be diagnosed later in life as well. The symptoms caused by ulcerative colitis originate from significant inflammation in the rectum that can then extend throughout the entire colon or large intestine. Signs and symptoms of ulcerative colitis can include abdominal pain, weight change, loose bowel movements or diarrhea, and significant bleeding with bowel movements. If the patient is experiencing the symptoms, they should seek evaluation with a gastroenterologist or colorectal surgeon, especially if there is a known family history of inflammatory bowel disease which can also include Crohn’s disease.
The medical and surgical management of ulcerative colitis depends on the severity of disease at the time of diagnosis and on the overall health and comorbidities of the patient. If symptoms are mild to moderate without any acute surgical issues, ulcerative colitis is initially managed with a variety of medications that are closely followed by a gastroenterologist. Despite significant advances in the medical management of ulcerative colitis, approximately 15-30% of patients with this disease will require some type of surgical intervention over their lifetime. Indications for surgical intervention can be acute or chronic. Indications for acute intervention can include severe and intractable bleeding, a perforation or tear in the colon or rectum, or severe colitis which is not responding to medications – also known as toxic mega colon. Chronic indications for surgery include a lack of a significant response to appropriate medical therapy, significant weight loss, or chronic bleeding and anemia that is requiring blood transfusions. Another indication for the surgical management of ulcerative colitis is the presence of a colorectal cancer or dysplastic lesions – significant pre-cancerous changes.
For the acute surgical management of ulcerative colitis, surgery will likely involve the removal of the entire colon or large intestine and creation of an ileostomy. The rectum, which is the end of the large intestine, will typically be left in place. Depending on the patient’s recovery from surgery and other factors related to inflammatory bowel disease, they may be a candidate for restoring continuity of the GI tract with a surgery known as a J-pouch. This will be determined in conjunction with your gastroenterologist and colorectal surgeon as you heal and recover from your initial surgery. Depending on a patient’s specific case, removal of the entire colon or large intestine can sometimes be performed through minimally invasive techniques, such as robotic/laparoscopic surgery.
When surgery is performed for more chronic issues related to ulcerative colitis, it will typically involve the removal of the entire colon and rectum. Depending on the indication for surgery, a permanent ileostomy may be created, or a J-pouch may be created during the same surgery. If a J-pouch is created, a temporary ileostomy will likely be created to allow your J-pouch to heal appropriately.
While surgery for ulcerative colitis involves a significant change in the anatomy of a patient, your gastroenterologist and colorectal surgeon will work with you to facilitate your recovery and optimize the treatment of your ulcerative colitis.