title: Rectosigmoid stump washout as an alternative to permanent mucous fistula in patients undergoing subtotal colectomy for ulcerative colitis in emergency settings.
abstract: BACKGROUND
  Restorative proctocolectomy with ileopouch-anal anastomosis (IPAA) is the treatment of choice for intractable or complicated ulcerative colitis(UC). Elderly patients often present with acute colitis requiring emergent subtotal colectomy(SC). Frail patients are at risk of developing septic complications related to the closed rectosigmoidal stump, often requiring formation of a second stoma to be reversed at the time of completion proctectomy. This carries nuisance to such exhausted patients. We propose a simple and inexpensive trick to avoid the need for creating a mucous fistula.
  
  
  METHODS
  IPAA was performed as a 3-stage procedure in emergency settings. The rectosigmoidal stump was closed and placed subcutaneously; skin was closed over it. After SC, if patients showed signs of stump-related pelvic sepsis, a lavage of the rectal stump with povidone iodine solution and with saline was carried out as a rescue treatment aiming to avoid the need of opening the rectal stump to drain sepsis.
  
  
  RESULTS
  Thirty-five patients underwent SC for UC between 1987 and 2012. The skin was closed over the closed stump in the 20. Seven patients out of these 20 experienced early stump-related septic complication. In five cases, we were able to avoid opening of the rectal stump, and a second stoma was unnecessary. After opening the closed stump in the remaining ones, a prompt improving of symptoms was observed.
  
  
  CONCLUSIONS
  Rectal washout was well tolerated and avoided a second stoma in five out of seven patients, with better quality of life and body perception after IPAA surgery. This is relevant when dealing with geriatric patients, needing to completely recover before undergoing completion proctectomy.
authors.affiliation: Department of Surgery, Unit of General and Geriatric Surgery, School of Medicine, Second University of Naples, Naples, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pellino
authors.forename: Guido
authors.initials: G
authors.lastname: Sciaudone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Candilio
authors.forename: Silvestro
authors.initials: S
authors.lastname: Canonico
authors.forename: Francesco
authors.initials: F
authors.lastname: Selvaggi
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000601:surgery*; D004630:Emergencies; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D011206:Povidone-Iodine / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D012965:Sodium Chloride; D011206:Povidone-Iodine