ABSTRACT
The probability of surgical indication in patients with ulcerative colitis is directly proportional to time of follow-up and extent of disease. The presence of extra-intestinal manifestations can corroborate the indication for surgical treatment. In case of suspected toxic megacolon, barium enema and colonoscopy are contraindicated because they can cause perforation or, if already present, unblock the lesion with consequent leakage of barium, causing peritonitis with very serious consequences. In emergency situations, the best approach is subtotal colectomy, closure of the rectal stump and terminal ileostomy. If using biological therapy improved the conditions of the rectum, it would be possible to indicate colectomy followed by ileorectal anastomosis instead of rectocolectomy with ileal pouch. Barreiro-de Acosta et al. studied 33 patients with pouchitis who were treated with infliximab and achieved complete response at 26 and 52 weeks, 33 and 27%, respectively, and partial response in 33 and 18%.
