PracticeParametersPracticeParametersfortheSurgicalTreatmentofUlcerativeColitisPreparedbyTheStandardsPracticeTaskForceTheAmericanSocietyofColonandRectalSurgeonsJeffreyL.Cohen,M.D.,ScottA.Strong,M.D.,NeilH.Hyman,M.D.,W.DonaldBuie,M.D.,GaryD.Dunn,M.D.,CliffordY.Ko,M.D.,PhillipR.Fleshner,M.D.,ThomasJ.Stahl,M.D.,DonaldG.Kim,M.D.,AmirL.Bastawrous,M.D.,W.BrianPerry,M.D.,PeterA.Cataldo,M.D.,JaniceF.Rafferty,M.D.,C.NealEllis,M.D.,JanRakinic,M.D.,SharonGregorcyk,M.D.,PaulC.Shellito,M.D.,JohnW.KilkennyIII,M.D.,CharlesA.Ternent,M.D.,WalterKoltun,M.D.,JoeJ.Tjandra,M.D.,CharlesP.Orsay,M.D.,MarkH.Whiteford,M.D.,JasonR.Penzer,M.D.TheAmericanSocietyofColonandRectalSurgeonsisdedicatedtoassuringhigh-qualitypatientcarebyadvancingthescience,prevention,andmanagementofdisordersanddiseasesofthecolon,rectum,andanus.TheStandardsCommitteeiscomposedofSocietymemberswhoarechosenbecausetheyhavedemonstratedexpertiseinthespecialtyofcolonandrectalsurgery.ThisCommitteewascreatedtoleadinternationaleffortsindefiningqualitycareforconditionsrelatedtothecolon,rectum,andanus.ThisisaccompaniedbydevelopingClinicalPracticeGuidelinesbasedonthebestavailableevidence.Theseguidelinesareinclusive,andnotprescriptive.Theirpurposeistoprovideinformationonwhichdecisionscanbemade,ratherthandictateaspecificformoftreatment.Theseguidelinesareintendedfortheuseofallpractitioners,healthcareworkers,andpatientswhodesireinformationaboutthemanagementoftheconditionsaddressedbythetopicscoveredintheseguidelines.Itshouldberecognizedthattheseguidelinesshouldnotbedeemedinclusiveofallpropermethodsofcareorexclusiveofmethodsofcarereasonablydirectedtoobtainingthesameresults.Theultimatejudgmentregardingtheproprietyofanyspecificproceduremustbemadebythephysicianinlightofallofthecircumstancespresentedbytheindividualpatient.METHODOLOGYAnorganizedsearchofMedline,PubMed,andtheCochraneDatabaseofCollectedReviewswasper-formedthroughSeptember2004.Key-wordcombina-tionsincludedulcerativecolitis,ilealpouch-analanas-tomosis,ileostomy,colorectalneoplasm,surgery,ileoproctostomy,andrelatedarticles.Directedsearchesoftheembeddedreferencesfromthepri-maryarticlesalsowereaccomplished.INDICATIONSFORSURGERYAcuteColitis1.Patientswithclinicalevidenceofactualorim-pendingperforationshouldundergourgentsur-Reprintsarenotavailable.Correspondenceto:NeilH.Hyman,M.D.,FletcherAllenHealthCare,111ColchesterAvenue,Fletcher301,Burlington,Vermont05401.DisColonRectum2005;48:1997–2009DOI:10.1007/s10350-005-0180-z©TheAmericanSocietyofColonandRectalSurgeonsPublishedonline:3October20051997gery.LevelofEvidence:III;GradeofRecommenda-tion:A.Severeacutecolitisaffectsbetween5to15percentofpatientswithulcerativecolitis.ThediagnosisofseverecolitisisbasedonthecriteriaofTrueloveandWitts1andisdefinedascolitiswithmorethansixbloodystoolsperday,fever(temperature,>37.5°C),tachycardia(heartrate,>90beatsperminute),anemia(hemoglobin,<75percentofnormal),andelevatedsedimentationrate(ESR,>30mmperhour).2Alterna-tively,toxic,orfulminant,colitisischaracterizedbymorethantenbloodystoolsperday,fever(tempera-ture,>37.5°C),tachycardia(heartrate,>90beatsperminute),anemia(transfusionrequired),elevatedsedi-mentationrate(ESR,>30mmperhour),colonicdila-tiononradiography,andabdominaldistentionwithtenderness.2Whenthecolonicdistentionofthetrans-versecolonexceeds6cm,thediagnosisbecomestoxicmegacolon.3,4Surgeryisrequiredin20...
