Ulcerative Colitis (eBook)

Gilberto Poggioli is a Full Professor of General Surgery at the University of Bologna. Focusing on the treatment of IBD for surgeons and gastroenterologists, he developed an extensive experience in clinical research, in particular on surgery of inflammatory bowel disease and abdominal procedures, both with a laparotomic and minimally invasive laparoscopic approach. His expertise in the treatment of patients with Crohn’s disease is demonstrated by more than 2000 procedures performed, including resective and bowel sparing surgery, while more than 1400 restorative proctocolectomies attest to his experience in the treatment of Ulcerative Colitis. Prof. Poggioli has also published nearly 350 papers in peer-reviewed journals and for national and international congresses.   

Cover 1
Half Title 1
Title Page 1
Copyright Page 1
Foreword 1
Preface 1
Contents 1
Contributors 1
1 History of Ulcerative Colitis 1
1.1 Introduction 1
1.2 Ancient Times 1
1.3 Discovery 1
1.3.1 First Case Reports 1
1.3.2 First Therapeutic and Diagnostic Attempts 1
1.3.3 1909 London Symposium 1
1.4 1910s–1950s 1
1.4.1 Breakthroughs and Growing Interest 1
1.4.2 Medical Therapy 1
1.4.3 Surgical Treatment 1
1.4.3.1 Ileostomy 1
1.4.3.2 Ileorectal Anastomosis 1
1.5 1960s–1990s 1
1.5.1 Medical Therapy Milestones (Table 1.1) 1
1.5.1.1 Aminosalicylates 1
1.5.1.2 Corticosteroids 1
1.5.1.3 Thiopurines and Ciclosporin 1
1.5.2 Surgical Milestones (Table 1.2) 1
1.5.2.1 Continent Ileostomy of Kock 1
1.5.2.2 Ileoanal-anastomosis and IPAA 1
1.5.3 Knowledge of Ulcerative Colitis in Italy 1
1.6 Ulcerative Colitis Therapy in the Modern Era (2000s–today) 1
References 1
2 Presentation and Natural Course of Ulcerative Colitis 1
2.1 Introduction 1
2.2 Definition and Classification 1
2.3 Epidemiology and Risk Factors 1
2.3.1 Epidemiology 1
2.3.2 Risk Factors 1
2.4 Pathogenesis 1
2.5 Clinical Features, Complications and Diagnosis 1
2.5.1 Clinical Features 1
2.5.2 Acute Complications 1
2.5.3 Diagnosis 1
2.6 Natural Course, Extra-intestinal Manifestations and Malignancies 1
2.6.1 Natural Course 1
2.6.2 Extra-intestinal Manifestations 1
2.6.3 Chronic Complication: Malignancies 1
References 1
3 Diagnosis of Ulcerative Colitis: the Role of Imaging Techniques 1
3.1 Introduction 1
3.2 Abdominal Radiography 1
3.2.1 Clinical Settings 1
3.2.2 Imaging Findings 1
3.3 Ultrasonography 1
3.3.1 Clinical Settings 1
3.3.2 Preparation 1
3.3.3 Imaging Findings 1
3.3.4 Scoring Systems 1
3.4 Computed Tomography 1
3.4.1 Clinical Settings 1
3.4.2 Preparation 1
3.4.3 Imaging Findings 1
3.4.4 Scoring Systems 1
3.5 Magnetic Resonance Imaging 1
3.5.1 Clinical Settings 1
3.5.2 Preparation 1
3.5.3 Imaging Findings 1
3.5.4 Scoring Systems 1
References 1
4 Diagnosis of Ulcerative Colitis:the Role of Endoscopy 1
4.1 Introduction 1
4.2 Diagnosis 1
4.2.1 Endoscopic Features of Ulcerative Colitis 1
4.2.2 Discontinuous Inflammation in Ulcerative Colitis 1
4.2.3 Mucosal Biopsies 1
4.2.4 Differential Diagnosis 1
4.2.5 Endoscopic Classification of the Disease (Extent and Severity) 1
4.2.6 Ulcerative Colitis Scoring Systems 1
4.3 Surveillance 1
4.4 Post-surgical Evaluation 1
4.4.1 Ileal Pouch Endoscopy 1
4.4.2 Surgery-associated Complications 1
4.4.2.1 Pouch Leaks 1
4.4.2.2 Pouch Sinus 1
4.4.2.3 Pouch Strictures 1
4.4.3 Inflammatory Complications 1
4.4.3.1 Pouchitis 1
4.4.3.2 Cuffitis 1
4.4.3.3 Pre-pouch Ileitis 1
4.4.4 Neoplastic Complications 1
References 1
5 Diagnosis of Ulcerative Colitis: Morphology and Histopathological Characteristics 1
5.1 Role of Histology 1
5.2 Histological Features 1
5.3 Differential Diagnosis 1
5.3.1 Crohn’s Disease and Indeterminate Colitis 1
5.3.2 Infectious Colitis 1
5.3.3 Diverticular Disease-associated Colitis 1
5.3.4 Diversion Colitis 1
5.3.5 Acute Ischemic Colitis 1
5.3.6 Radiation Colitis 1
5.3.7 Microscopic Colitis 1
5.3.8 Drug and Preparation Solution-induced Colitis 1
5.4 Ulcerative Colitis and Neoplasia 1
5.4.1 Adenocarcinoma and Dysplasia-associated Lesion or Mass 1
5.4.2 Lymphoma and Ulcerative Colitis 1
5.4.3 Kaposi Sarcoma 1
5.5 Complications 1
5.5.1 Pouchitis 1
5.5.2 Cuffitis 1
5.5.3 Pre-pouch Ileitis 1
5.5.4 Crohn’s Disease-like Complications of the Pouch 1
5.6 Infections 1
5.6.1 Cytomegalovirus 1
5.6.2 Clostridium difficile 1
5.7 Ulcerative Colitis in Children 1
References 1
6 Medical Treatment of Ulcerative Colitis: Does Traditional Therapy Still Have a Role? 1
6.1 Introduction and Definitions 1
6.2 Management of Mild-to-moderate Activity 1
6.2.1 Proctitis 1
6.2.2 Left-sided and Extensive Colitis 1
6.3 Management of Severe Activity 1
6.4 Maintenance of Remission 1
6.5 Special Situations 1
References 1
7 Evolution of Surgical Treatment of Ulcerative Colitis 1
7.1 Introduction 1
7.2 Proctocolectomy with Brooke Ileostomy 1
7.3 Proctocolectomy with the Kock Pouch 1
7.4 Abdominal Colectomy and Ileorectal Anastomosis 1
7.5 Restorative Proctocolectomy with Ileoanal Anastomosis 1
7.6 Minimally Invasive Surgery 1
7.7 Salvage Surgery after Failed Restorative Proctocolectomy 1
References 1
8 Surgical Treatment of Ulcerative Colitis: How Has the Timing of Surgery Changed? 1
8.1 Introduction 1
8.2 Surgical Procedure 1
8.3 Pharmacological Treatment and Surgery 1
8.3.1 Steroids 1
8.3.2 Immunosuppressive Therapy 1
8.3.3 Biological Therapies 1
8.4 Conclusion 1
References 1
9 Surgical Treatment of Ulcerative Colitis: Indications and Techniques 1
9.1 Introduction 1
9.2 Surgical Indications 1
9.2.1 Acute Colitis 1
9.2.2 Chronic Colitis 1
9.2.3 Dysplasia and Cancer 1
9.3 Surgical Techniques 1
9.3.1 Restorative Proctocolectomy with IPAA 1
9.3.2 Proctocolectomy 1
9.3.3 Creation of an Ileal Pouch 1
9.3.4 Lengthening of the Ileum 1
9.3.5 Ileoanal Anastomosis 1
9.3.6 Diverting Ileostomy 1
References 1
10 Surgical Treatment of Ulcerative Colitis: Laparoscopy and New Minimally Invasive Techniques 1
10.1 Introduction 1
10.2 Subtotal Colectomy 1
10.2.1 Technique 1
10.3 Restorative Proctectomy with Ileal Pouch-anal Anastomosis 1
10.3.1 Technique 1
10.4 Future Developments 1
References 1
11 Results and Quality of Life after Surgical Treatment of Ulcerative Colitis 1
11.1 Introduction 1
11.2 Functional Outcomes in Pediatric Patients 1
11.3 Functional Outcomes in Older Patients 1
11.4 Changes in Functional Results over Time 1
11.5 Pelvic Sepsis after IPAA and Functional Results 1
11.6 Pouch Design and Functional Results 1
11.7 Functional Outcomes According to Type of Pouch Anal Anastomosis 1
11.8 Functional Outcomes in Patients with Crohn’s Disease 1
11.9 Restorative Proctocolectomy and Sexual Function 1
References 1
12 Long-term Complications after Surgical Treatment of Ulcerative Colitis 1
12.1 Introduction 1
12.2 Pouchitis 1
12.3 Pre-pouch Ileitis 1
12.4 Cuffitis 1
12.5 Anastomotic Stenosis 1
12.6 Crohn Disease of the Pouch 1
12.7 Irritable Pouch Syndrome 1
12.8 Mega Pouch 1
References 1
13 Management and Treatment of Fistulas after Surgical Treatment of Ulcerative Colitis 1
13.1 Introduction 1
13.2 Diagnosis 1
13.3 Treatment 1
13.3.1 Early Pouch-anal Fistulas 1
13.3.2 Late Fistulas 1
13.3.2.1 Pouch-anal Fistulas 1
13.3.2.2 Pouch-vaginal Fistulas 1
13.4 Conclusions 1
References 1