Over recent years, the majority of reports strongly suggest that subtotal or total colectomy with Brooke ileostomy are the safest and most widely used operations in acute severe ulcerative colitis . A two- or three-stage procedure can be performed. Stage I consists of subtotal or total abdominal colectomy with a sigmoid or rectal stump closure and an end ileosto-my [35, 36]. Once the majority or the totality of the diseased colon is removed, the patient's clinical condition will improve, allowing the tapering off of steroids or immunosuppressive therapy. Once the patient has recovered and is clinically fit for another operation, stage II IRA or total proctectomy with end ileostomy or restorative procedure with or without diverting loop ileostomy is carried out . Stage III involves reversal of the ileostomy. Occasionally, persistent bleeding from the retained rectal stump can be observed, but in most cases, it can be controlled by topical steroids application.
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