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Ulcerative colitis, one of the idiopathic inflammatory bowel diseases (IBDs), is a chronic disease that affects the mucosa of the rectum and colon. Although Hippocrates described diarrheal diseases that were colitis-like well before 360 bc, it was not until the late 1800s that ulcerative colitis was distinguished clinically from common infectious enteritis. Sir Samuel Wilks of London is credited with the first medical account of colitis. In 1859, he described a 42-year-old woman who died after several months of diarrhea and fever. Postmortem examination revealed a transmural ulcerative inflammation of the colon and terminal ileum that, while originally designated as “simple ulcerative colitis,” may in fact have been Crohn's disease. A subsequent case report in 1875, again by Wilks and Walter Moxon, described ulceration and inflammation of the entire colon in a young woman who had succumbed to severe bloody diarrhea, and it is more likely the first detailed account of ulcerative colitis.

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The landmark description of regional enteritis in the 1930s, by Crohn, Ginzburg, and Oppenheimer, led to the recognition of the existence of two IBDs: Crohn's disease and ulcerative colitis. Although the two diseases initially appeared to have distinct pathologic features, it is now recognized that there can be significant overlap not only pathologically but also in anatomic distribution and clinical manifestations. Furthermore, there may be overlap in the underlying cause of the two diseases.

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Ulcerative colitis typically manifests with periods of remission and exacerbations characterized by rectal bleeding and diarrhea. Because ulcerative colitis most commonly affects patients in their youth or early middle age, the disease can have serious long-term local and systemic consequences. The etiology remains essentially unknown, but there have been significant advances in identifying likely genetic and environmental factors that contribute to its pathogenesis. Despite this, there is no definitive medical treatment for the disease. Medical therapy can only ameliorate the inflammatory process and control symptomatic flares. Thus, surgery has an important role in the management of ulcerative colitis as it is estimated that approximately 40% of patients with ulcerative colitis will ultimately require surgery.1

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Proctocolectomy or total removal of the colon and rectum has been the standard surgical treatment for ulcerative colitis. In recent years, a number of other options have become available so a permanent ileostomy is not required. Irrespective of the surgical procedure, most patients can expect to lead normal lives with a high quality of life. However, in order to achieve these outcomes, patients must be carefully assessed and selected for surgery and receive optimal perioperative care. The surgery itself can be technically challenging, and postoperative complications must be recognized and managed appropriately. All of these require that surgeons have an understanding of the epidemiology and pathophysiology of ulcerative colitis, its clinical manifestations, medical management as well as issues related to surgical technique, preoperative assessment, and postoperative care of patients.

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Ulcerative colitis poses many challenges to the epidemiologist because the incidence of ...

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