Patient I: 30 M with 1st episode of bloody diarrhea

1
Emergency surgery in ulcerative colitis

• Patient I 30 M with 1st episode of bloody
  diarrhea
• Proctosigmoidoscopy ulcerative colitis
• gt 10motions/day - partial response to medical
  management
• Surgical opinion - day 5
• Refused surgery - ostomy unacceptable
• Symptoms worsened - operated day 10
• Findings caecal perforation with localized
  abscess
• Procedure total colectomy ileostomy mucus
  fistula
• Turbulent post operative period at present, has
  completed 3 stages and is well

2
Emergency surgery in ulcerative colitis

• Patient II 36F with a 4-year history of
  recurrent bloody diarrhea
• UC diagnosed on colonoscopy and biopsy
  pancolitis
• Present episode15 stools/day with blood,
  cramps
• Poor response to medical therapy
• Surgical referral (day 8) s.alb1.8, K 2.0, pedal
  edema
• Procedure total colectomy ileostomy
• Outcome died day 3

3
Emergency surgery in ulcerative colitis

• Patient III known case of ulcerative colitis
• prolonged steroid and immunosuppresant use
• presented with acute attack - very poor general
  condition
• poor response to medical therapy
• operated ileostomy under LA - survived total
  colectomy in same admission