Ulcerative Colitis: Surgical Management [sounds like]
8 results
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Perioperative- Benign Disease
- A 47-year-old male patient with a history of ulcerative colitis, who is currently taking vedolizumab, presents for routine screening colonoscopy. He has mild proctosigmoiditis, and a 5-mm semipedunculated polyp is noted in the sigmoid colon. What is the best management approach for this polyp?
- A patient with ulcerative colitis refractory to medical therapy undergoes total proctocolectomy. Which extraintestinal manifestation is most likely to persist after the colectomy?
- A 28-year-old man with a history of ulcerative colitis undergoes a total proctocolectomy with stapled ileal pouch–anal anastomosis. Six months after surgery, he presents with urgency, increased stool frequency, and bloody bowel movements. Endoscopic examination findings are shown (Figure A and B). What is the best next step in management?
- A 37-year-old man with a history of ulcerative colitis treated with infliximab and azathioprine is admitted to the hospital with abdominal distention, pain, and a fever of 98.6°F (37°C). After 24 hours of intravenous (IV) methylprednisolone, IV levofloxacin and metronidazole, bowel rest, and resuscitation, his heart rate has increased to 120 beats/min and his temperature is 102.2°F (39°C). Urgent computed tomography reveals megacolon without perforation. The best next step in management is:
- A 55-year-old woman presents to your office for surgical consultation. Colonoscopy had demonstrated hundreds of adenomas carpeting the colon and 30 polyps in the rectum. She has never had a problem with fecal incontinence. What is the best next step in management?
- A 54-year-old woman with a 22-year history of ulcerative colitis undergoes screening colonoscopy. Results of all previous colonoscopies have been negative for dysplasia. In the ascending colon, a flat polyp is resected. Pathology reveals low-grade dysplasia in a background of quiescent (inactive) colitis. What is the most appropriate next step in management?
- A 50-year-old man who underwent a restorative total proctocolectomy with an S-pouch 20 years ago for ulcerative colitis presents with a 2-year history of progressively worsening severe difficulty with evacuation, bloating, and a constant feeling of incomplete evacuation. A flexible pouchoscopy reveals a patent pouch-anal anastomosis with a 7-cm angulated efferent limb to a normal-appearing pouch. These findings are confirmed on a contrast pouchogram. Defecography demonstrates normal pelvic floor relaxation with contrast retained in the pouch despite maximum straining. What is the most appropriate treatment option?