Obstruction in a patient with long-standing ulcera-tive colitis results almost invariably from malignancy . Usually, the obstruction is only partial and the patient can be prepared for an elective procedure. Complete acute obstruction occurs infrequently and the patient presents as an emergent case. A thorough clinical exam and upright films of the abdomen can easily establish the diagnosis. In such cases, the surgeon should act as in other cases of acute colonic obstruction and operate on the patient shortly after the diagnosis, but should always have in mind that ulcerative colitis as an underlying disease alters the operative strategy demanding total colectomy. Since the obstruction in a long-standing ulcerative colitis is highly suspicious for malignancy, the operation should be performed utilizing standard oncologic principles. If the rectum is not involved, total colec-tomy with a Hartmann's procedure or mucus fistula should be performed. When the rectum is involved, proctocolectomy and terminal ileostomy with preservation of anal sphincters is suggested if the oncologic procedure is not compromised. In very rare circumstances, colectomy with abdominoperineal resection of rectum is the only solution.
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