Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBD), with the other type being Crohn's disease. It is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer.
A colostomy is an opening (stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it into place. This opening, often in conjunction with an attached ostomy system, provides an alternative channel for feces to leave the body. Thus if the natural anus is unavailable for that function, an artificial anus takes over. It may be reversible or irreversible, depending on the circumstances.
Familial adenomatous polyposis (FAP) is an autosomal dominant inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine. While these polyps start out benign, malignant transformation into colon cancer occurs when they are left untreated. Three variants are known to exist, FAP and attenuated FAP are caused by APC gene defects on chromosome 5 while autosomal recessive FAP is caused by defects in the MUTYH gene on chromosome 1. Of the three, FAP itself is the most severe and most common; although for all three, the resulting colonic polyps and cancers are initially confined to the colon wall. Detection and removal before metastasis outside the colon can greatly reduce and in many cases eliminate the spread of cancer.
Ileostomy is a stoma constructed by bringing the end or loop of small intestine out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an external ostomy system which is placed next to the opening. Ileostomies are usually sited above the groin on the right hand side of the abdomen.
In medicine, the ileal pouch–anal anastomosis (IPAA), also known as restorative proctocolectomy (RPC), ileal-anal reservoir (IAR), an ileo-anal pouch, ileal-anal pullthrough, or sometimes referred to as a J-pouch, S-pouch, W-pouch, or a pelvic pouch, is an anastomosis of a reservoir pouch made from ileum to the anus, bypassing the former site of the colon in cases where the colon and rectum have been removed. The pouch retains and restores functionality of the anus, with stools passed under voluntary control of the person, preventing fecal incontinence and serving as an alternative to a total proctocolectomy with ileostomy.
Colectomy is bowel resection of the large bowel. It consists of the surgical removal of any extent of the colon, usually segmental resection. In extreme cases where the entire large intestine is removed, it is called total colectomy, and proctocolectomy denotes that the rectum is included.
Megacolon is an abnormal dilation of the colon. This leads to hypertrophy of the colon. The dilation is often accompanied by a paralysis of the peristaltic movements of the bowel. In more extreme cases, the feces consolidate into hard masses inside the colon, called fecalomas, which can require surgery to be removed.
Pouchitis is an umbrella term for inflammation of the ileal pouch, an artificial rectum surgically created out of ileum in patients who have undergone a proctocolectomy or total colectomy. The ileal pouch-anal anastomosis is created in the management of patients with ulcerative colitis, indeterminate colitis, familial adenomatous polyposis, cancer, or rarely, other colitides.
Pancolitis or universal colitis, in its most general sense, refers to inflammation of the entire large intestine comprising the cecum, ascending, transverse, descending, sigmoid colon and rectum. It can be caused by a variety of things such as inflammatory bowel disease, more specifically a severe form of ulcerative colitis. A diagnosis can be made using a number of techniques but the most accurate method is direct visualization via a colonoscopy. Symptoms are similar to those of ulcerative colitis but more severe and affect the entire large intestine. Patients generally exhibit symptoms including rectal bleeding as a result of ulcers, pain in the abdominal region, inflammation in varying degrees, and diarrhea, fatigue, fever, and night sweats. Due to the loss of function in the large intestine patients may lose large amounts of weight from being unable to procure nutrients from food. In other cases the blood loss from ulcers can result in anemia which can be treated with iron supplements. Additionally, due to the chronic nature of most cases of pancolitis, patients have a higher chance of developing colorectal cancer.
A colorectal polyp is a polyp occurring on the lining of the colon or rectum. Untreated colorectal polyps can develop into colorectal cancer.
Pouchoscopy is a minimally invasive endoscopic procedure to examine an ileo-anal pouch, a replacement for the colon / rectum which is surgically created from the small intestine (ileum) as treatment for ulcerative colitis, a preventive measure in certain genetic illnesses such as FAP or HNPCC or as a procedure in the treatment of colon cancer. Typically, a fiber optic camera on a flexible tube is passed through the anus. Pouchoscopy is the first line test to evaluate pouch dysfunction, and is used for surveillance in individuals with genetic cancer syndromes (FAP). While pouchoscopy may help assess the integrity of the J-pouch, this evaluation is more commonly completed using a pouchogram. A pouchoscopy is normally part of a routine follow up and is used to confirm the diagnosis of pouchitis and cuffitis.
Sir Alan Guyatt Parks was a British colorectal surgeon, who served as president of the Royal College of Surgeons.
Nils G. Kock was a professor of surgery who taught and practiced at the University of Gothenburg, Gothenburg, Sweden. Kock was noted for his research, experimentation, and colorectal surgical techniques. These led to his breakthrough development of the Kock pouch, used for people who require excretory stomas.
Cuffitis is inflammation at the anal transition zone or "cuff" created as a result of ileal pouch-anal anastomosis (IPAA). It is considered a variant form of ulcerative colitis that occurs in the rectal cuff. Cuffitis is a common complication of IPAA, particularly when a stapled anastomosis without mucosectomy procedure has been used.
Steven D. Wexner is an American surgeon and physician. He is Director of the Ellen Leifer Shulman and Steven Shulman Digestive Disease Center at Cleveland Clinic Florida. Wexner has received numerous regional, national, and international research awards. Through his multiple academic appointments, Wexner personally trains 15-20 surgeons each year, and he educates thousands more around the world through conferences and lectures. He is a resource for his colleagues from around the world for referral of patients with challenging or complex problems. In 2020, he was elected vice-chair of the Board of Regents of the American College of Surgeons for a one-year term. Since 1990. he has served as Symposium Director of the Cleveland Clinic Annual International Colorectal Disease Symposium. The Symposium was held in Fort Lauderdale or Boca Raton every year from 1990 to 2019. Since 2020, the Symposium has expanded to include host locations outside of the US with interruptions during the pandemic years of 2021–2022.
Colonic ulcer can occur at any age, in children however they are rare. Most common symptoms are abdominal pain and hematochezia.
Bryan Nicholas Brooke MD, M.Chir., was a British surgeon and pioneer of surgery for ulcerative colitis.
Fabrizio Michelassi, M.D., F.A.C.S. is the Lewis Atterbury Stimson Professor, and Chairman of the Department of Surgery at Weill Cornell Medicine and Surgeon-in-Chief at NewYork-Presbyterian/Weill Cornell Medical Center.
Segmental colitis associated with diverticulosis (SCAD) is a condition characterized by localized inflammation in the colon, which spares the rectum and is associated with multiple sac-like protrusions or pouches in the wall of the colon (diverticulosis). Unlike diverticulitis, SCAD involves inflammation of the colon between diverticula, while sparing the diverticular orifices. SCAD may lead to abdominal pain, especially in the left lower quadrant, intermittent rectal bleeding and chronic diarrhea.
Ralph John Nicholls, FRCS (Eng), EBSQ is a retired British colorectal surgeon, Emeritus Consultant Surgeon at St Mark’s Hospital London and Professor of Colorectal Surgery, Imperial College London.
