Ulcerative colitis (UC) is a chronic disease characterized by diffuse mucosal inflammation limited to the colon. UC complications are bleeding, Toxic colitis and colon cancer. UC patient rarely presented with stenosis or fistula. Strictures develop in 5 to 10 percent of patients with UC. We report a rare case of an unusual complication with UC benign stricture and fistula. Case: 49-year-old female who is Jehovah`s Witness presented with left flank pain and fever that had begun two weeks ago. She had been diagnosed with UC 20 years ago. However she arbitrarily had stopped visiting hospital and relied on home remedies. When she visited the hospital, blood pressure was 130/80 mmHg, heart rate was 110/min, and temperature was 38.1℃. Physical examination showed that tender mass accompanied by heating sense, redness was touched in her left flank. Laboratory records showed reduced hemoglobin and leucocytosis as hemoglobin 5.0 g/dL WBC 16100/mm3 ESR 70 mm/hr, CRP 6.7 mg/dl. Abdominopelvic computed tomography scan revealed haustral marking loss in T-colon, luminal narrowing and, extraperitoneal fistula formation in descending colon. She was started on intravenous antibiotics and the abscess was drained percutaneously. She was treated transverse colostomy because of severe stricture. 6 month later, colonoscopy showed shortening of the colon and severe stricture. Reconstructive surgery seemed impossible. She was treated with total colectomy with ileal pouch-anal anastomosis 13 month after she had been treated colostomy. Pathological finding showed that there was no malignant cell and no granuloma lesion. It seemed typical ulcerative colitis. In conclusion, untreated UC patient presented with severe stricture, fistula and abscess. We treated with antibiotics and total colectomy and ileal pouch-anal anastomosis.