IBD IBD Surgical Management

Question 1

What is the surgical procedure of choice for ulcerative colitis that is refractory to medical therapy?

Accepted Answer

Proctocolectomy with ileal pouch-anal anastomosis (IPAA / J-pouch)

Answer

Total colectomy with end ileostomy alone (permanent)

Answer

Subtotal colectomy with ileorectal anastomosis

Answer

Hartmann's procedure with mucous fistula

Question 2

In the setting of fulminant colitis or toxic megacolon, which surgical approach is performed emergently?

Accepted Answer

Subtotal colectomy with end ileostomy (Hartmann's pouch)

Answer

Total proctocolectomy with immediate IPAA

Answer

Sigmoid colectomy only

Answer

Diverting loop ileostomy alone

Question 3

Strictureplasty in Crohn's disease is performed to address which problem while preserving bowel length?

Accepted Answer

Short fibrostenotic strictures without active inflammation or malignancy

Answer

Fistula closure

Answer

Perianal abscess drainage

Answer

Resection of dysplastic segments

Question 4

Which perianal Crohn's complication requires examination under anesthesia (EUA) with seton placement?

Accepted Answer

Complex perianal fistula

Answer

Simple anal fissure

Answer

Hemorrhoidal disease

Answer

Rectal prolapse

Question 5

Which criterion is an absolute surgical indication in IBD management?

Accepted Answer

Perforation, uncontrolled hemorrhage, or malignancy

Answer

Mild disease refractory to first-line medications

Answer

Elevated CRP despite therapy

Answer

Frequent flares managed as outpatient

Question 6

What percentage of UC patients will ultimately require colectomy over their lifetime?

Accepted Answer

30–40%

Answer

<5%

Answer

10–15%

Answer

>60%