Multiple Rectal Ulcers (14 of 110)

Twenty to 25% of patients with extensive ulcerative colitis eventually undergo colectomy, usually because their disease has not responded to medical therapy. The decision between surgery and continued medical therapy is often not clear-cut, and in many cases arguments can be made for either course. In ulcerative colitis, colectomy is a “curative” procedure, in contrast to Crohn’s disease, in which there is a significant likelihood of recurrence some time after the colectomy. The development of the ileoanal anastomosis, eliminating the need for an ileostomy, has made the thought of colectomy more tolerable for many. In general, patients who require continuous high-dose cortico-steroids and/or immunosuppressants to keep their disease under control should be strongly advised to consider colectomy. Those at high risk for colonic carcinoma (pancolitis of greater than 10 to 15 years duration) should also be considering colectomy or alternatively entry into a colonoscopic surveillance program.