Indeterminate Colitis

Indeterminate colitis creates problems when surgical treatment of patients with colitis is being contemplated. Total colectomy with ileoanal pull-through is the operation of choice for most patients with ulcerative colitis. This same operation is contraindicated in patients with Crohn’s disease. Patients with indeterminate colitis without perianal disease and without small bowel involvement may do well with an ileoanal pull-through operation, while most patients with indeterminate colitis and perianal disease are likely to have problems with this operation. Sometimes the colon has typical features of ulcerative colitis, and later the patient may be found to have Crohn’s disease. Most patients in this category have small bowel recurrence or onset of severe perianal disease. The majority ultimately require excision of the neorectum and Brooke ileostomy.