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

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* For further information see power point presentation on UC and Crohns/Role of surgery in colitis