Segmental Colectomy: An Alternative for Ulcerative Colitis in Endoscopic Remission?

Abstract

Frontali et al.1 recently published a retrospective multicentric experience of segmental colectomy [SC] in 72 patients diagnosed with ulcerative colitis [UC] and in endoscopic remission. After SC, postoperative early colitis was rare [7.0%], suggesting that SC could be a surgical alternative for UC patients in endoscopic remission. Despite the relevant information described, some important issues need to be discussed. First, 23.0% of all patients underwent surgical resection due to sigmoid diverticulitis, which leads us to question the diagnosis of UC. In those patients, would not the correct diagnosis be a segmental colitis associated with diverticulosis [SCAD]? Both conditions may exhibit similar clinical manifestations. Patients with SCAD usually present with rectal bleeding and, occasionally, with abdominal pain and diarrhoea. Endoscopically, SCAD manifests as a segmental colitis restricted to the sigmoid colon, where diverticula are observed.2 Therefore, in this group of patients, the absence of endoscopic recurrence may have...