CT enterography is performed and is consistent with pancolitis. The patient has ongoing frequent bowel movements with up to 10 bloody stools a day over the first 3 days. Her CRP on day 3 of steroids is 62 mg/dL.
Which of the following are indications for colectomy in a hospitalized patient with UC? (more than one answer may apply)
Severe Ulcerative Colitis with C. Difficile Infection
Clostridium Difficile infection should be treated as this can confound symptoms of acute severe ulcerative colitis. This is not an absolute indication for surgery.
Detection of CMV infection on endoscopic biopsies
Cytomegalovirus infection should be treated as this can confound symptoms of acute severe ulcerative colitis. This is not an absolute indication for surgery.
Toxic Megacolon
Non obstructive colonic dilation on imaging with organ dysfunction and systemic toxicity are indications for urgent colectomy in ASUC.
Colonic Perforation
Perforation is an absolute indication for urgent colectomy in ASUC.
Severe or refractory hemorrhage
Severe or refractory hemorrhage is an indication for urgent colectomy in ASUC as the bleeding is often not amenable to endoscopic therapy.
Failure of glucocorticoid therapy
Colectomy should be considered in those who are refractory to 3-5 days of IV steroids
Failure of anti-TNF or cyclosporine therapy
Colectomy should be considered in those who are refractory to 3-5 days of IV steroids, especially if they do not respond to rescue therapy with anti-TNF or cyclosporine.
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