Inflammatory Bowel Disease

Ulcerative Colitis (UC) is a continuous mucosal inflammation that begins at the anorectal junction and extends proximally to involve the colon. The inflammation is characteristically limited to the mucosal layer. Crohn’s Disease (CD) is characterized by transmural inflammation that can affect any segment of the GI tract from mouth to anus, with skip areas of normal tissue between diseased segments. Failure of medical treatment, both in emergency and elective situations, is an indication for surgery. Non-remitting acute fulminant colitis, toxic megacolon, colonic perforation, and massive lower GI bleeding are indications for emergency surgery. Staged restorative proctocolectomy (J pouch ileoanal anastomosis) is the surgical procedure of choice for UC. Treatment of CD is essentially medical; surgery is more often palliative. Surgery in CD is indicated for failure of medical treatment to achieve remission or to treat complications like stricture, fistulae, or lower GI bleeding.