If you are experiencing a medical emergency, contact emergency services immediately: Emergency contacts and medical assistance
Crisis Scenario 1 — Acute Severe Ulcerative Colitis (ASUC)
Acute severe UC is a medical emergency requiring immediate hospital admission. The Truelove & Witts criteria for ASUC: ≥ 6 bloody stools per day PLUS at least one of: fever > 37.8°C, tachycardia > 90 bpm, haemoglobin < 10.5 g/dL, or ESR > 30mm/hr.
Warning signs — go to the emergency room immediately: - Six or more bloody stools in 24 hours - High fever and rapid pulse alongside profuse bloody diarrhoea - Severe abdominal pain and distension (possible toxic megacolon) - Faintness or dizziness with ongoing bleeding (haemodynamic compromise) - Sudden severe abdominal pain with rigidity (possible perforation — surgical emergency)
What to do: 1. Go to the emergency room. Do not delay. 2. Call your gastroenterologist en route if possible — they need to be involved from the first hours. 3. Tell the treating team: your UC extent (pan-colitis / left-sided / proctitis), current medications (especially if on biologic), last colonoscopy findings, and steroid history.
What happens in hospital: IV methylprednisolone 60mg/day is the first-line treatment for ASUC. If no response by day 3, rescue therapy (infliximab IV or cyclosporine IV) is initiated. If rescue therapy fails, colectomy is discussed. The Gauss decision tree (steroid-refractory threshold by day 3) guides this — your gastroenterologist and colorectal surgeon will work together.
Crisis Scenario 2 — Toxic Megacolon
Toxic megacolon is a rare but life-threatening complication of severe UC — the colon dilates acutely (transverse colon diameter > 6cm on X-ray) with systemic toxicity (fever, tachycardia, leucocytosis). Perforation risk is very high.
Warning signs: - Severely distended, tender abdomen - Sudden reduction or cessation of diarrhoea (paradoxical — the bowel has stopped working) - High fever and rapid deterioration
What to do: Emergency room immediately. This is a surgical emergency. Colectomy is often required urgently. IV hydration, antibiotics, gastric decompression, and urgent colorectal surgical review.
Crisis Scenario 3 — Colectomy: The Financial Scenario
Your gastroenterologist and colorectal surgeon have decided colectomy is the right option. This may be emergency (toxic megacolon, perforation, refractory ASUC) or elective (refractory medical management, cancer risk, patient preference). What will this cost?
Let's focus on what we can control.
| Situation | What Applies |
|---|---|
| CDL registered + in-network colorectal surgeon | Procedure is PMB-covered. OOP is minimal if surgeon bills at scheme rate. |
| CDL registered + surgeon bills above scheme rate | Gap cover pays shortfall. Colorectal surgeons frequently bill above scheme rate. |
| Staged IPAA (2–3 stage procedure) | Each stage is a separate admission. Each creates specialist shortfall exposure. |
| Emergency colectomy (unplanned) | PMB covers emergency. Call scheme's 24-hour authorisation line within 48 hours. |
| No gap cover | Shortfall on colorectal surgeon + anaesthesiologist per stage: R15,000-R40,000. |
Important: IPAA is typically a two or three-stage procedure. Each stage is a separate major operation — each generates its own specialist shortfall exposure. If you have gap cover, the shortfall accumulates across all stages.
What Happens After Colectomy?
A successful IPAA restores near-normal bowel function. Average frequency: 4–8 stools per day, mostly controlled. Long-term complications: pouchitis (inflammation of the J-pouch — responds to antibiotics), vitamin B12 deficiency (terminal ileum removed or bypassed), and occasional pouch failure requiring revision.
After a successful IPAA: no ongoing biologic or 5-ASA medication required. Annual pouch surveillance endoscopy replaces colonoscopy. The IBD chapter closes. This is the unique characteristic of UC that distinguishes it from Crohn's.
Gap Cover: What It Does for UC
| Scenario | Gap Cover Helps? |
|---|---|
| 5-ASA medication | NO — CDL-funded |
| Biologic OOP cost | NO — formulary issue |
| ASUC hospitalisation: gastro shortfall | YES |
| Emergency colectomy: colorectal surgeon shortfall | YES — very significant |
| Elective IPAA colectomy (Stage 1): surgeon shortfall | YES |
| Elective IPAA colectomy (Stage 2 + 3): surgeon shortfall | YES — each stage separately |
| Colectomy sub-limit exposure | YES — sub-limit cover products specifically |
Bottom line: Gap cover for UC is primarily about colectomy — the colorectal surgeon shortfall across multiple surgical stages is the major financial exposure. 5-ASA and azathioprine management is CDL-funded, so the medicine itself rarely leaves a shortfall.
In Hospital Right Now
- Call your scheme's 24-hour authorisation line (on the back of your medical aid card) within 48 hours of admission.
- Ask each treating doctor their billing rate — the gastroenterologist and colorectal surgeon may both bill above scheme rate.
- Notify your gap insurer immediately with the admission date, treating doctors, and procedure planned.
- If considering elective colectomy, request a full written cost estimate covering all surgical stages before consenting.
Know your UC cover before a flare or surgery. Run your AURA check