Inflammatory Bowel Disease — Surgical

A 32-year-old man with a 12-year history of ulcerative colitis presents with acute onset of severe abdominal pain, fever (38.5°C), and tachycardia (HR 110/min). Abdominal examination reveals marked distension and tenderness. Plain abdominal X-ray shows a dilated colon with a maximum diameter of 8 cm. Serum albumin is 2.8 g/dL, and CRP is 85 mg/L. He has failed medical management with intravenous corticosteroids and infliximab over the past 10 days. What is the most appropriate next step in management?

A 28-year-old woman with Crohn's disease (ileocolic disease, diagnosed 8 years ago) undergoes elective ileocolic resection for recurrent obstruction despite medical management. Intraoperatively, the surgeon notes multiple strictures in the terminal ileum and proximal colon, with fistulizing disease to the adjacent small bowel loop. After resection of the diseased segment and primary anastomosis, the patient develops anastomotic leak on postoperative day 5, presenting with fever, peritonitis, and sepsis. What is the most appropriate immediate management?

In ulcerative colitis, which layer of the colon is primarily affected by inflammation?

Which surgical procedure is considered the definitive curative treatment for ulcerative colitis?

A 32-year-old man with a 12-year history of ulcerative colitis presents with acute onset of severe abdominal pain, fever (38.8°C), and bloody diarrhea (15 stools/day). On examination, the abdomen is distended and tender. Plain abdominal X-ray shows a dilated transverse colon (8 cm) with loss of haustra and multiple air-fluid levels. Serum albumin is 2.8 g/dL, hemoglobin 8.2 g/dL, and C-reactive protein 18 mg/dL. He has failed 5 days of high-dose IV corticosteroids and IV antibiotics. What is the most appropriate next step in management?