Emergency management of Ulcerative colitis is by

(D) Total Proctocolectomy with end ileostomy# OPERATIVE MANAGEMENT OF ULCERATIVE COLITIS:> Emergent Operation:- In a patient with fulminant colitis or toxic megacolon, total abdominal colectomy with end ileostomy, rather than total proctocolectomy, is recommended.> Although the rectum is invariably diseased, most patients improve dramatically after an abdominal colectomy, and this operation avoids a difficult and time-consuming pelvic dis- section in a critically ill patient. Rarely, a loop ileostomy and decompressing colostomy may be necessary if the patient is too unstable to withstand colectomy.> Definitive surgery may then be undertaken at a later date once the patient has recovered.> Complex techniques such as an ileal pouch anal reconstruction generally are contraindicated in the emergent setting.> However, massive hemorrhage that includes bleeding from the rectum may necessitate proctectomy and either a permanent ileostomy or ileal pouch anal anastomosis.> Elective Operation:- In the past, abdominal colectomy with ileorectal anastomosis often was recommended for patients with relatively quiescent rectal disease.> Risk of ongoing inflammation, the risk of malignancy, and the availability of restorative proctocolectomy have led most surgeons to now recommend elective operations that include resection of the rectum.> Abdominal colectomy with ileorectal anastomosis is still an appropriate operation for a patient with indeterminate colitis and rectal sparing.> Total proctocolectomy with end ileostomy has been the "gold standard" for patients with chronic ulcerative colitis.> This operation removes the entire affected intestine and avoids the functional disturbances associated with ileal pouch-anal reconstruction.> Most patients function well physically and psychologically after this operation.> Total proctocolectomy with continent ileostomy (Kock's pouch) was developed to improve function and quality of life after total proctocolectomy, but morbidity is significant and restorative proctocolectomy generally is preferred today.> Since its re introduction in 1980, restorative proctocolectomy with ileal pouch-anal anastomosis has become the procedund of choice for most patients who require total proctocolectomy but wish to avoid a permanent ileostomy.