Abstract: Surgical treatment of ulcerative colitis (UC) has received increasing attention. Total proctocolectomy with ileal pouch anal anastomosis (IPAA) has become a stan dard procedure. Acute severe UC (ASUC) is a difficult point of treatment. The commonly used strategy is to determine whether conversion therapy is performed after the observation of hormone therapy. Critical UC (CUC) is more urgent and complex due to the critical condition of the disease, which is often combined with uncontrollable massive hemorrhage, toxic megacolon or colonic perforation. Therefore, higher requirements for surgical and perioperative management are necessary. At present, when surgeons face CUC patients, what surgical strategy should be adopted is still lack of unified standard. The authors intended to sort out the timing, operation procedure and postoperative management of CUC so as to give full play to the value of surgical treatment and to improve the prognosis of CUC patients.