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

Restorative proctocolectomy with IPAA (J-pouch) removes all diseased colorectal mucosa while preserving continence, and is the preferred definitive surgery for UC.

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

Emergency subtotal colectomy with end ileostomy stabilizes the critically ill patient while preserving the rectum for future IPAA reconstruction after recovery.

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

Strictureplasty widens short fibrostenotic strictures without bowel resection, preserving intestinal length and reducing the risk of short bowel syndrome in Crohn's patients with multiple prior resections.

Question 4

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

Accepted Answer

Complex perianal fistula

Answer

Complex perianal fistulas in Crohn's require EUA for accurate mapping and seton placement to drain the tract, prevent abscess formation, and allow anti-TNF therapy to be effective.

Question 5

Which criterion is an absolute surgical indication in IBD management?

Accepted Answer

Perforation, uncontrolled hemorrhage, or malignancy

Answer

Perforation, life-threatening hemorrhage, and colorectal malignancy are absolute emergent surgical indications that require immediate operative intervention regardless of other factors.

IBD - Inflammatory Bowel Disease Practice Test

IBD - Inflammatory Bowel Disease Practice Test

IBD IBD Surgical Management