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The cause of Ulcerative Colitis is unknown but its incidence is increasing. The disease is nearly always confined to the large bowel (colon and rectum) although it may be found in the last part of the small bowel (terminal ileum) known as “backwash ileitis”. It is characterised by a number of different findings that may be seen endoscopically (usually at colonoscopy), at surgery and histologically (when examined under the microscope).
Any age group may be affected but it is most commonly seen as two peaks of incidence, one in young adults (aged 15-25 years) and another in the sixth decade of life. Women are more often than men and family history of inflammatory bowel disease and associations with some rarer medical conditions are sometimes identified.
- Abdominal Pain – Usually cramp-like in nature
- Change in bowel habit – Usually to diarrhoea
- Rectal bleeding
- Weight loss
Some, none or all of the above may be present in people with Ulcerative Colitis.
Why does the disease give these symptoms?
Ulcerative Colitis characterised by inflammation and ulceration of the lining (mucosa) of the large bowel where the disease is usually confined. As a result of this inflammation this lining fails in its primary function of absorbing water and electrolytes from bowel contents and is particularly prone to bleeding and excess mucous production and loss. Without treatment the bowel wall thins and dilates; this compromises its blood supply and ultimately gangrene develops and perforation may occur.
Pharmacological treatment of Ulcerative Colitis is undertaken by specialist physicians (gastroenterologists) and consists of anti-inflammatory and immune-modulating drugs as well as nutritional and supportive care. Surgeons become involved usually at the request of these physicians when disease will not respond to treatment or when complications intervene. When surgery is required specialist colorectal surgeons seek to remove most or more usually all areas of affected bowel (the colon) and attempt to restore normal bowel anatomy and function.
It is natural that patients, their families and medical professionals often consider surgery (usually a total colectomy) as a last resort and strive to exhaust all avenues of pharmacological treatment first. Whilst it is true to say that such treatments have “saved” some very badly inflamed colons it should be recognised that for some, significant delay to the inevitability of surgery may be costly.
This is seen in terms of the time spent unnecessarily unwell, the extent of surgery that becomes required and the time taken to fully recover. As ever, full and frank discussion with experts in both the medical and surgical management of the disease is mandated.
What are the reasons for operation?
- Persistence of symptoms despite medical treatment
- Toxicity and Dilation
- Perforation of the bowel
- Development of bowel cancer or dysplastic masses.
A variety of different operations are undertaken either in a laparoscopic or open fashion. The operation performed will depend on the site of disease and its severity as well as the age and wishes of the patient.
Commonly performed operations are:-
- Proctocolectomy and ileostomy/ Koch pouch
- Subtotal Colectomy and Ileostomy/ Mucous Fistula
- Ileorectal Anastomosis
- Ileal Pouch Anal Anastomosis
- Left Colectomy /Anterior Resection