In the management of acute severe ulcerative colitis, colonoscopy is generally considered when?

• A. It is always performed
• B. It is avoided during severe colitis unless necessary
• C. It is never performed
• D. It is performed immediately on admission

Answer: (B)

During a severe flare of ulcerative colitis, the colon is inflamed, fragile, and often distended, which makes colonoscopy risky. Endoscopy can increase the chance of perforation, bleeding, and can worsen the patient’s condition, especially if there’s toxic megacolon or hemodynamic instability. For this reason, colonoscopy is not routine in the acute severe phase and is generally avoided unless there is a compelling reason to obtain diagnostic information that would change management. Such reasons include ruling out other causes of colitis (like infections such as C. difficile or CMV) when results would alter treatment, or evaluating the patient after initial stabilization when deciding on long-term management or surgery. If a procedure is needed, it’s done cautiously and only after the patient is stabilized.