Abstract Background Emergency colectomy in inflammatory bowel disease (IBD) has become less common in recent years due to earlier diagnosis, improved disease monitoring and broader access to biologic and small-molecule therapies. These advances reduced progression to fulminant colitis and toxic megacolon, historically major drivers of urgent surgery. The COVID-19 pandemic, however, disrupted elective care, restricted outpatient follow-up and limited access to endoscopy and infusion centres. Such constraints raised concerns that delays in treatment optimisation could increase acute surgical presentations. Assessing whether these pressures resulted in measurable changes in the IBD surgical burden in Brazil is crucial for future planning. Methods We conducted an ecological time-series study using aggregated data from the DATASUS Hospital Information System (SIH-SUS). Annual counts of emergency colectomies coded under ICD-10 K50–K51 were extracted and stratified by the five Brazilian macro-regions. To explore temporal behaviour across the six-year interval, simple linear regression was performed. Regional proportions were compared descriptively to evaluate geographic disparities in access to acute IBD surgical care. Results Between 2019 and 2024, a total of 169 emergency colectomies for IBD were recorded nationwide. Annual procedure volumes were consistently low: 44 in 2020, followed by 37, 35, 35 and 14 in subsequent years. Despite the transient rise during the first pandemic year, linear regression showed no significant long-term trend (β = –0.21; p = 0.78), indicating overall temporal stability and suggesting that disruptions in outpatient IBD services during COVID-19 did not translate into sustained increases in acute surgical presentations. Regionally, the Southeast accounted for 63% of all cases, while the Northeast, South and Centre-West contributed approximately 11–12% each; the North represented only 2%. These patterns likely reflect structural disparities in specialist availability, referral pathways, diagnostic capability and coding accuracy, rather than true regional differences in disease biology. Conclusion Emergency colectomy for IBD remains a rare event within the Brazilian public healthcare system and showed no meaningful increase during or after the COVID-19 pandemic. The striking regional concentration of procedures in the Southeast highlights persistent inequities in access to advanced IBD care and underscores the importance of strengthening diagnostic networks, referral systems and regional specialised services. Continuous monitoring of surgical outcomes is essential to guide equitable national strategies for IBD management. References: 1. Ng SC, Shi HY, Hamidi N, et al. 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Conflict of interest: Prof. Dr. Da Silva Cornelio, Thiago: No conflict of interest Fernandes Notaro, Daniela: No conflict of interest Caroline de Almeida, Erica: No conflict of interest Fusco Seixas, Rafaela: No conflict of interest Pereira Dos Reis, Milena: No conflict of interest Mendes Andrade, Vanessa: No conflict of interest Julia Machado, Ana: No conflict of interest Oliveira Mendonça Giraud, Laryssa: No conflict of interest Moreira Marinho, Isabela: No conflict of interest Jabur Fasolin, Luisa: No conflict of interest Faria Fernandes, Flávia: No conflict of interest Aureliano Moysés, Renato: No conflict of interest de Farias Gama Siqueira, Elienai: No conflict of interest Laura Peres Leite, Ana: No conflict of interest Sales da Silveira, Guilherme: No conflict of interest Camargo dos Santos Leal, Juliana: No conflict of interest Campos Kirschner Moraes, Lavínia: No conflict of interest
Cornelio et al. (2026) studied this question.