Colorectal Surgery — MCQs

Q: Procedure of choice in ulcerative colitis with acute perforation is

Total colectomy and ileostomy. ***Total colectomy and ileostomy*** - **Acute perforation** in ulcerative colitis is a life-threatening emergency requiring immediate and definitive surgical management. - **Total colectomy** removes the diseased colon, preventing further perforation and systemic toxicity, with an ileostomy providing fecal diversion. *Defunctioning ileostomy* - A defunctioning ileostomy alone would not address the actively perforated and inflamed colon, leaving the source of sepsis intact. - This procedure leads to potentially fatal **peritoneal contamination** and ongoing inflammation. *Closure of perforation* - Direct closure of a colonic perforation in the context of acute ulcerative colitis is generally contraindicated due to the **fragile, inflamed, and friable bowel tissue**, which is prone to dehiscence. - This approach carries a high risk of **re-perforation** and persistent sepsis. *Proximal diversion colostomy* - A proximal diversion colostomy, similar to a defunctioning ileostomy, fails to remove the diseased and perforated segment of the colon. - It would not prevent the continued leakage of bowel contents from the perforation site into the **abdominal cavity**, leading to severe peritonitis.

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