Fate of the rectum after colectomy and ileostomy for Crohn's colitis.
Eighty-four patients had colectomy with ileostomy and oversewing of the rectum for Crohn's colitis. Seventy-two patients were operated on because of intractable disease, colitis in combination with rectal fistulas, and toxic megacolon. The operative mortality was 6 percent, and neither emergency surgery nor treatment with steroids correlated with operative morbidity. After a median 7.7 years of follow-up, 25 ileorectal anastomoses had been undertaken, 16 of which were successful. Twenty-nine protectomies were performed; the resulting 10-year cumulative risk of proctectomy was 50 percent. While the risk of proctectomy was significantly less among patients with a normal rectum at colectomy compared with patients with proctitis, the initial macroscopic degree of proctitis did not correlate with the risk of subsequent proctectomy. The 5-year cumulative ileal resection rate in 29 patients with a rectum in situ but out of circuit was 29 percent. The possibility of a future ileorectal anastomosis should still be considered in patients with proctocolitis.
Department of Surgical Gastroenterology C, Rigshospitalet, University of Copenhagen, Denmark.
H
H
Harling
J
J
Hegnhøj
T N
TN
Rasmussen
S
S
Jarnum
D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D003082:Colectomy; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation