Colitis
Ulcerative colitis
Lesions continuous – superficial
Rectum always involved
- Terminal ileum involved in 10%
- Granulated ulcerated mucosa
- Fibrous strictures rare
- Fistulae rare
- Anal lesions in <20%
Crohns
- Lesions patchy – penetrating
- Rectum normal in 50%
- Terminal ileum involved in 30%
- Discretely ulcerated mucosa
- Strictures common
- Enterocutaenous or intestinal fistulae in 10%
- Anal lesions in 75%
Assessment of disease severity
- Mild = < 4 stools per day. Systemically well
- Moderate = > 4 stools per day. Systemically well
- Severe = > 6 stools per day. Systemically unwell
- Systemic features include tachycardia, fever, anemia, hypoalbuminaemia
Indications for surgery – Ulcerative colitis
- 20% of patients with ulcerative colitis require surgery at some time
- 30% of those with total colitis require colectomy within 5 years
Emergency
- Total colectomy with ileostomy and mucus fistula
Elective
- Panproctocolectomy and Brooke ileostomy
- Panproctocolectomy and Kock continent ileostomy
- Total colectomy and ileorectal anastomosis
– Maintains continence but proctitis persists
- Restorative proctocolectomy with ileal pouch
– Need adequate anal musculature
– Need for mucosectomy unclear
– May need defunctioning ileostomy
Videos
J pouch- first 2 weeks patient experience
* For further information see power point presentation on UC and Crohns/Role of surgery in colitis