[Surgical indications in ulcerative colitis: European approach]

Ulcerative colitis can only be cured by surgery. Colonic perforation and rectocolic cancer are absolute indications for surgery. Severe attacks of ulcerative colitis are classically managed for 5 days by intensive medical treatment, including intravenous and rectal corticosteroids. Colectomy must be performed if this treatment fails. Although not universally accepted, endoscopy is of great help to select patients needing early surgery. Finally, chronic continuous and cortico-dependent forms will obviously benefit from surgery. Proctocolectomy with ileal pouch-anal anastomosis clearly makes certain surgical decisions somewhat easier.