A 42-year-old man with long-standing ulcerative colitis undergoes surveillance colonoscopy. A 2 cm raised, non-lifted mass lesion with high-grade dysplasia (DALM) is found in the descending colon. The recommended surgical treatment is:
- A Total proctocolectomy with ileal pouch-anal anastomosis ✓
- B Segmental colectomy
- C Endoscopic resection with close follow-up
- D Increased surveillance frequency
Correct answer: A. Total proctocolectomy with ileal pouch-anal anastomosis
Explanation
A dysplasia-associated lesion or mass (DALM) in ulcerative colitis is an indication for total proctocolectomy because of high risk of synchronous or metachronous cancer. Segmental resection is inadequate given the field defect. Endoscopic resection is not appropriate for a mass lesion with high-grade dysplasia.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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