**Question:** Procedure of choice in ulcerative colitis with acute perforation is:

A. Resection and anastomosis
B. Colectomy
C. Hemicolectomy
D. Proctocolectomy

**Correct Answer:** **B. Colectomy**

**Core Concept:**
Ulcerative colitis is a type of inflammatory bowel disease (IBD) that affects the colon and rectum. When an acute perforation occurs in ulcerative colitis, it is crucial to select the appropriate surgical procedure to manage the complication and prevent further complications.

**Why the Correct Answer is Right:**
Colectomy, often referred to as subtotal colectomy or Hartmann's procedure, is the correct procedure for managing acute perforation in ulcerative colitis. This procedure involves the removal of the inflamed colon and rectum, leaving the healthy sigmoid colon and rectum attached to the remaining colon. This allows for temporary decompression of the abdomen by creating an ostomy (usually a colostomy) and a rectal stump to prevent further contamination and complications.

**Why Each Wrong Option is Incorrect:**

A. Resection and anastomosis (rectal resection) may not be sufficient to address the perforation and the underlying inflammation. In this scenario, the inflammation extends beyond the rectum, necessitating removal of the affected colon as well.

C. Hemicolectomy involves removing only part of the colon, which may not adequately address the severe inflammation and perforation in ulcerative colitis.

D. Proctocolectomy (cecal resection) removes the entire colon, rectum, and anus, which is not the procedure of choice for acute perforation in ulcerative colitis, as it does not address the primary concern of perforation and inflammation in the colon.

**Clinical Pearl:**

In the context of acute perforation in ulcerative colitis, colectomy is the preferred surgical procedure to remove the inflamed colon and rectum, ensuring proper management of the complication and prevention of further complications. This procedure ensures complete surgical excision of the inflamed segment of the colon and rectum, allowing for ostomy formation and preventing abdominal contamination.