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Severe acute colitis is a serious complication of ulcerative colitis (UC). It can be life-threatening for the patient. Its definition is based on a set of clinico-biological and/or endoscopic criteria. In the event of any outbreak of UC, severe acute colitis must be ruled out. Therapeutic management is multidisciplinary. It must be rapid, first of all eliminating a complication requiring emergency surgical treatment. Several molecules are currently available in the therapeutic arsenal for this entity. The difficulty in managing it is to entrust the patient to the surgeon at the right time.