For patients with ulcerative colitis unresponsive to medical therapy, colectomy is often needed. The small intestine is brought up to an opening in the abdominal skin and formed into an ostomy (Image B). An ostomy bag sits outside to collect the waste. The ostomy can be a permanent end-ileostomy, or a temporary ostomy, depending on the situation.
In some cases, the ileum (small bowel) is brought down into the pelvis, shaped into a pelvic pouch, and connected to the anus – ileal pouch-anal anastomosis (IPAA, or J-pouch) surgery.
Since the surgery occurs deep in the pelvis, injury can occur to the fallopian tubes (a reproductive organ through which an egg travels from the ovary to the uterus); scarring and adhesions that form after the surgery can block the fallopian tubes.
For women who need a colectomy but also wish to have children, it is suggested that they have the colectomy with a temporary ileostomy until they have finished having children. Then they can undergo the IPAA procedure to create a J pouch.
For more information on IBD surgeries and fertility, please go to our IBD surgery and fertility resources page.