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In about 25-30% of persons with ulcerative colitis, medical treatment is not completely successful.
In such persons and in persons with dysplasia, surgery may be considered.
First option: removal of the entire colon and rectum (proctocolectomy) with the creation of an ileostomy.
Second option: removal of the colon, creation of an internal ileal pouch (from the small intestine) with attachment to the anal sphincter muscle (ileoanal anastomosis), and creation of a temporary ileostomy. After the ileoanal anastomosis heals, the ileostomy is closed; and passage of feces through the anus is reestablished.