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Ulcerative colitis (UC) usually involves the rectum and may extend proximally to the rest of the colon. In an emergency setting, total colectomy with a terminal ileostomy is usually performed. In selected cases, the emergency surgery is followed by further completion of the proctectomy with a J-pouch and an ileal pouch-anal anastomosis (IPAA). Total mesorectal excision has been the preferred way to perform the proctectomy, although a close rectal dissection (CRD), without following the holy plane, has also been described and has the potential to better preserve the autonomic function. The transanal approach has evolved and is no longer limited to oncological indications, but can also be used in cases of UC requiring surgery. Hybrid transanal CRD seems to be a valid alternative for proctectomy.
