What are the contraindications to surgery for ulcerative colitis (UC)?

Updated: Apr 01, 2019
  • Author: E Stanton Adkins, III, MD; Chief Editor: Harsh Grewal, MD, FACS, FAAP  more...
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Answer

Answer

The only absolute contraindication for surgical treatment of UC is anal sphincter dysfunction. Preexisting incontinence due to neurologic impairment or other causes makes reservoir construction unnecessary and makes ileoanal pull-through inadvisable.

Other contraindications include suspected Crohn disease. The diagnosis of UC must be certain before an ileal pouch reservoir is created in a patient with inflammatory bowel disease (IBD). The need for pelvic irradiation is also a contraindication to pelvic reservoir construction. For example, if rectal cancer is found at the time of exploration, end ileostomy should be performed in anticipation of postoperative pelvic irradiation. Radiation leads to pouch fibrosis and noncompliance, with resultant loss of reservoir function.


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