Surgical alternatives for the treatment of ulcerative colitis include all of the following except:

B. Left colectomy with colorectal anastomosis.

DISCUSSION: Ulcerative colitis is a mucosal inflammatory disease confined to the rectum and colon. It can thus be cured by total proctocolectomy. For that reason, the standard of therapy for many years was total proctocolectomy and ileostomy. In an effort to avoid permanent ileostomy a number of other alternatives have been evaluated, including subtotal colectomy with ileorectal anastomosis, proctocolectomy with continent ileostomy, and colectomy with endorectal ileal pouch–anal anastomosis. In the past, subtotal colectomy with ileorectal anastomosis was accepted as a compromise operation, with the knowledge that disease-bearing rectal tissue was retained. Because other definitive alternatives are currently available, ileorectal anastomosis is no longer appropriate for elective surgical treatment of ulcerative colitis. In an acutely ill patient or when the diagnosis is in question, subtotal colectomy with ileostomy and Hartmann closure of the rectum is the most expeditious choice and allows later restorative surgery. Partial colectomy has never been an acceptable alternative for elective operative management of ulcerative colitis; thus, left colectomy with colorectal anastomosis would not be an appropriate alternative.