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Benign Disease
A 28-year-old woman presents with pan-ulcerative colitis since age 16 years. Her symptoms were previously well-controlled with vedolizumab and mesalamine, but she has recently begun to experience frequent flares of disease. She is interested in having children and is referred for consideration of elective surgery involving a restorative proctocolectomy with an ileal pouch–anal anastomosis. What is the postsurgical effect on future childbearing about which you would counsel the patient?
Malignancy
A 40-year-old woman presents to your office with constipation and vague lower back pain. On digital rectal examination, you palpate a smooth mass posteriorly at the tip of your finger. Colonoscopy findings were normal, save for posterior bulging with smooth mucosa in the rectum. Magnetic resonance imaging (MRI) shows a solid mass in the rectorectal space with bony destruction of the sacrum. What is the next best management step for this patient?
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