Ulcerative Colitis Surgery

The risk of surgery increases with the duration and extent of disease. Many people with ulcerative colitis (UC) may never require surgery. Currently, there is no medicinal cure for ulcerative colitis, and 25% to 40% of ulcerative colitis patients will eventually have their colons removed because of severe illness, risk of cancer, massive bleeding, or rupture of the colon.

Your doctor may recommend surgery for a number of reasons. Perhaps you have not responded to medical treatment, or the side effects of corticosteroids or other drugs are threatening your health. If you do have to undergo surgery, you may have one of two common procedures.

Ileostomy

During an ileostomy, the surgeon creates a small opening in the abdomen, called a stoma, and attaches the end of the small intestine, called the ileum, to it. The stoma is about the size of a quarter and is covered by a pouch. Waste travels through the small intestine and exits the body through the stoma and into the pouch. The patient empties the pouch as needed.

Ileoanal anastomosis

Ileoanal anastomosis is a fairly new procedure that allows the patient to have normal bowel movements because it preserves the anus. The colon is still removed, but the doctor creates an internal pouch from the small bowel and attaches it to the anal sphincter muscle. Waste is stored in the pouch and is passed through the anus in the usual manner.

Complications

As with any surgery, there are complications that can happen. The two most common complications are small bowel obstruction and pouchitis, an inflammation of the pouch. An obstruction of the bowel will cause crampy abdominal pain, nausea, and vomiting. In most people, this can often be treated with intravenous fluids and by allowing the bowel to rest. However, some people may require surgery to eliminate/remove the obstruction.

Pouchitis

In pouchitis, patients may experience diarrhea, urgency to have bowel movements, the feeling that they still need to have a bowel movement right after having one, and, occasionally, abdominal cramps, fever, and joint pain. Pouchitis is usually treated with an antibiotic for three to six weeks. In a small number of patients, pouchitis becomes chronic, requiring them to take long-term antibiotics and/or other medications.

Which surgery you have will depend on the severity of the disease and your needs, expectations, and lifestyle. If your doctor has said you need surgery, it is important that you get as much information as possible about the different procedures and what to expect from each. Talk to your doctor and nurses, and ask if they can help you contact other patients who have undergone these procedures.

Toxic megacolon

In some cases, ulcerative colitis patients may need emergency surgery. This is usually done to treat a condition called toxic megacolon, a severe complication that involves damage to the entire thickness of the intestinal wall. With toxic megacolon, the normal contractile movements of the intestinal wall temporarily stop, preventing the contents of the intestine from emptying. If your doctor suspects that you have toxic megacolon, he or she will have you stop taking all antidiarrheal drugs. You will be hospitalized and receive all fluids, nutrition, and drugs intravenously. You will be closely monitored, and if your condition does not improve within 24 to 48 hours, your doctor will likely recommend emergency surgery to remove all or most of the large intestine.