Synopsis
Refer for IBD surgery before avoidable physiological decline, prepare patients for realistic operative choices, manage stoma complications, and prevent or detect Crohn postoperative recurrence objectively.
- IBD surgery is indicated for emergency complications, medically refractory disease, fixed structural damage, dysplasia or cancer, and sometimes a patient preference for a more predictable life.
- Crohn surgery treats the complication but does not cure the disease; preserve bowel length where safe and plan recurrence prevention before discharge.
- In acute severe UC, deteriorating toxic megacolon, perforation, major haemorrhage or failed medical rescue requires timely subtotal colectomy rather than repeated immunosuppression.
Key red flags
A new stoma that becomes dusky, black, deeply retracted or stops functioning with pain and vomiting needs urgent surgical review for ischaemia, obstruction or retraction.
Investigation priorities
Define obstruction, perforation, abscess, anastomotic leak or postoperative collection in an acute presentation.
Management branches
Structural complication, dysplasia, refractory inflammation, repeated steroid dependence or unacceptable quality of life makes an operation plausible.
- Define the surgical question with current endoscopy, imaging, pathology and medical history, separating active inflammation from fibrosis, sepsis and malignancy risk.
- Discuss options jointly with an IBD colorectal surgeon before exhausting every medicine, including expected bowel function, recurrence and the option of no operation now.
Key medicines
Oral rehydration solutionSodium-glucose formulation and daily volume prescribed by the stoma or nutrition team.
LoperamideRegular pre-meal specialist regimen titrated within the local high-output stoma protocol.