Treatment of inflammatory bowel disease is a challenge. Many surgeons are not enthusiastic about treatment of patients with Crohn's disease or ulcerative colitis. During recent decades, specialised centres have been created where a team of skilled surgeons, gastroenterologists, radiologists, pathologists, and psychologists guarantee an optimal management of patients with IBD. This opportunity should be offered to IBD patients whenever possible. However, in case of emergencies such as toxic megacolon, bowel perforation, bleeding, and intestinal obstruction, treatment In Loco is unavoidable. Transfer to a specialised centre, which doesn't always mean the next closest hospital, may be very dangerous for patients with IBD emergencies. An immediate surgical intervention is required, and the surgeon has to know what to do. This is expecially true for patients presenting with acute abdominal pain as a first manifestation of IBD, a rare event nowadays.

Since ulcerative colitis and Crohn's disease are not extremely rare, doctors in peripheral hospitals are familiar with them. Surgical management of patients with IBD is not extremely difficult from the technical point of view. The question is when and how to choose the right approach. Decisions made in emergency situations, or better, before these develop, are made in an interdisciplinary way. For instance, every patient with IBD should be evaluated by the gastroenterologist and the surgeon together at the time of the initial hospital admission and at every readmission thereafter.

Histologic examination of biopsies may be hazardous. A proven diagnosis of Crohn's disease is generally seen as precluding ileal pouch-anal anastomosis. This problem exists in peripheral hospitals as well as in big institutions.

In a peripheral hospital such as ours, there is a surgeon, a gastroenterologist and endoscopist, a radiologist, a blood bank, an intensive care unit, and a CT-scan available. Using these resources, we have treated patients with IBD emergencies with the results reported above (Table 2). If we have to resolve emergency situations regarding IBD patients, some planned operations should also be done. Treatment of IBD patients in our department is performed in accordance and in synchronisation with our gastroenterologist and specialised centres. We do not carry out ileal pouch-anal anastomoses because of the low number of patients requiring this operation at our hospital.

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