Review Article

The Practical Management of Acute Severe Ulcerative Colitis

D. Seah; P. De Cruz


Aliment Pharmacol Ther. 2016;43(4):482-513. 

In This Article

Surgical Management

Patients who do not respond to medical therapy must be rapidly made ready for surgery. Operative management of ASUC should ideally occur in a semi-elective rather than emergency setting and a staged approach has been widely adopted. To underpin this point, a recent systematic review and meta-analysis demonstrated a significantly higher post-operative mortality in patients with UC, following emergent but not elective colectomy (5.3% and 0.7%).[121] Patients generally undergo a laparoscopic proctocolectomy and ileostomy, followed by an ileal pouch-anal anastomosis. The close timing of medical salvage therapy and surgical intervention has raised safety concerns. The majority of data investigating the pre-operative use of infliximab and ciclosporin has been retrospective in nature. When compared to matched controls, the number of complications was not significantly different at 1-month follow-up after pre-operative salvage therapy in patients with surgically managed ASUC.[122,123] The impact of perioperative salvage therapy on post-operative outcomes is yet to be fully explored.