The American Society of Colon and Rectal Surgeons Annual Scientific Meeting presented data that showed postoperative complications and longer hospital stays were more common in patients with acute ulcerative colitis, for whom surgery was postponed. Ira Leeds, general surgery resident of the department of Surgery at John Hopkins University School of Medicine, and his colleagues observed patients with a diagnosis of acute ulcerative colitis who were hospitalized and underwent emergency surgical procedures between the years 2008 and 2013. Out of 225,154 patients who were admitted for UC at the time, 6,819 underwent emergency surgery. The researchers recognized that a lower rate of complications (43.2% vs. 54.9%) and shorter hospital stays (8.2% vs. 28.6%) was seen among the patients who underwent early surgery. Therefore, they came to the conclusion that undergoing early surgical intervention can improve outcomes in patients with acute ulcerative colitis. However, Dr. Leeds noted the limitations of the study, which specified that the medical management systems and the reasons for changes in the timing of the surgery remain unknown.
Paul Collins, lecturer in medicine and honorary registrar in gastroenterology and Jonathan Rhodes, professor of Medicine, also reviewed the diagnosis and management of ulcerative colitis. They provided a thorough review of both medical treatments and surgical management required for ulcerative colitis. Collins and Rhodes stated that 15% of patients with ulcerative colitis will experience a severe attack, requiring them to undergo hospitalization at the time of their disease. These patients are generally treated with intravenous corticosteroids, with a 60% response rate and the remaining 40% requiring further treatment via colectomy. It is harmful to the patient to proceed with medical treatment if they do not respond properly to the treatment that they are given. Furthermore, if surgery is postponed, their condition may worsen. Therefore, these findings suggest that speeding up the urgency for acute ulcerative colitis surgery can, in fact, prevent the possibility of worsening an individual’s postoperative outcome.
How is acute ulcerative colitis diagnosed?
Your doctor will ask you about your symptoms, do a physical examination, as well as run a few tests. The most common tests for diagnosing acute ulcerative colitis include the following:
- Colonoscopy – your doctor will use a thin, lightened tool to examine the inside of your entire colon. He or she may even take a sample of the lining of the colon for further testing (known as a biopsy);
- Flexible sigmoidoscopy – your doctor will use a thin, lightened tool to take a look at the sigmoid, the last section of your colon. If he or she notices that it is extremely inflamed, you may need to undergo a full colonoscopy.
- Blood test – your doctor will use a small, thin needle to take a blood sample from you that will reveal any signs of infection or inflammation;
- Stool sample test – your doctor will take a sample of your stool to look for any signs of infection, blood, and white blood cells
The tests results will reveal whether you have acute ulcerative colitis and rule out other conditions such as irritable bowel syndrome or Crohn’s disease.
When and why is acute ulcerative colitis surgery needed?
The most common reason why your doctor may recommend undergoing surgical treatment is when medical treatment for acute ulcerative colitis becomes refractory. In such instances, it is imperative to undergo surgery, typically abdominal colectomy with end ileostomy and Hartmann closure of the rectum, early in the treatment course in order to reduce the risk of unwanted complications. Additional reasons as to why surgery may be necessary for acute ulcerative colitis include the following:
- Rupture of the colon
- Excessive bleeding
- Extreme and persistent side effects
- Severe and sudden onset of the disease
- High risk of cancer
- The onset of toxic megacolon
For elderly patients with acute ulcerative colitis, total proctocolectomy with permanent ileostomy remains the optimal choice. However, choosing the best option when it comes to treatment requires an individualized approach and involves collaboration between you, your physician, and your colorectal surgeon.
You may even choose to have surgery if your symptoms begin to affect your daily activities and overall quality of life. If you have any of the following symptoms, it is important that you seek immediate medical attention:
- Bowel obstruction – nausea, cramps, and vomiting;
- Pouch inflammation – fever, frequent bowel movements, abdominal cramps, diarrhea, and pain in the joints;
- Pouch failure – fever, pain, and swelling
What are the different types of surgical procedures for treating acute ulcerative colitis?
Essentially, the only approach to treating acute ulcerative colitis is to undergo surgery to remove the diseased colon and rectum. There are several different types of surgical procedures recommended by doctors for treating acute ulcerative colitis. They include the following:
- Colectomy - a surgical procedure that involves removing the entire colon;
- Proctocolectomy - a surgical procedure that involves removing both the colon and the rectum (considered the standard surgical treatment for ulcerative colitis);
- Pelvic pouch or ileal pouch anal anastomosis (IPAA) – a surgical procedure that involves removing both the colon and rectum, then forming an internal pouch – known as the J-pouch – with the small intestine. The J-pouch will play the role of the new rectum;
- Permanent ileostomy – a surgical procedure that involves removing the entire colon and creating an opening (stoma) in the abdominal wall. The top of the lower small intestine is then brought through the stoma and an external bag is attached to it;
- Continent ileostomy – a surgical procedure that involves removing both the colon and rectum, then forming an internal reservoir from the small intestine. An opening is made in the abdominal wall and the reservoir is joined to the skin with a nipple valve. In order to drain the pouch, you must insert a catheter through the nipple valve and into the internal reservoir. This procedure is not typically recommended due to ambivalent results and the possibility of needing additional surgery.
In most cases, the risk of developing cancer is more than 30x the normal rate if you do not undergo surgery. Therefore, undergoing surgical treatment can lower and even eliminate your risk of developing colon cancer. If the entire colon and rectum are removed with surgery, ulcerative colitis can be fully cured. This, in turn, should alleviate any symptoms you may have been experiencing such as abdominal pain, persistent diarrhea, anemia, and other symptoms. After the surgery, you will need to stay in the hospital for up to a week. During this time, your surgeon will monitor your condition for any signs of complications or unwanted side effects. The recovery period following surgery for acute ulcerative colitis is typically 4-6 weeks. To help improve your recovery, you need to maintain a healthy diet, get plenty of nutrients, stay hydrated, stay active, and manage your stress levels.
Talk with your doctor and health care team about any questions or concerns that you may be having before the surgery so that you are aware of what you can expect. More so, do not hesitate to reach out to your family, friends, and loved ones. Even seeking help from a support group may help you to feel better about your decision and allow you to gain some insight from other individuals who are going through the exact same thing you are.
While it is only natural to feel concerned about undergoing any type of surgery, remember that early surgical intervention for acute ulcerative colitis can help you to gain more control of your digestive system and better manage your overall health.