**2.4 Colitis in Crohn disease**

Some of the patients with an acute severe colitis inaugural picture have indeterminate colitis or Crohn colitis. When they indicate emergency surgery, the first step is the colectomy. The realization of an elective restorative proctectomy with an IPAA must be individually analyzed. Patients with CD after IPAA, when compared with UC, have a fivefold higher risk of failure, twofold risk of strictures, and a sixfold risk of fistulae. This risk is much higher if the diagnosis is performed only after IPAA. However, function in those who retain the pouch seemed similar to that of patients with UC. CD does not increase the risk of pouchitis. IPAA could be offered to a selected population of CD patients after proper preoperative counseling (**Figure 10**).

Ileal pouch rectal anastomosis seems to be another viable alternative to permanent ileostomy in Crohn's proctocolitis patients. IPRA offers durable preservation

**Figure 10.** *Nine years after IPAA in a patient with Crohn's disease.*

of bowel continuity and proper function and quality of life (QOL) in selected CC patients who might otherwise require a permanent ileostomy [25].
