Completion Proctectomy for Crohn's Colitis: Lessons Learned.
Surgical management of Crohn's disease is reserved for patients refractory to medical therapy and those who develop complications alleviated by surgery. Surgical resection may be the most efficient way to restore health in patients with stricturing and or fistulizing disease of the terminal ileum / small bowel. However, decision-making in patients with Crohn's colitis is more difficult. The merits of segmental resection versus subtotal/total colectomy versus total proctocolectomy with end ileostomy are affected by a myriad of factors, including extent of colon involvement, the patient's age, and the patient's degree of desire to avoid an ileostomy. In patients undergoing a total proctocolectomy for Crohn's colitis, the anal canal should be removed. The following case highlights the potential difficulty that may arise when the anal canal is left in situ.
Department of Colorectal Surgery, University College Hospital Galway, Galway, Ireland.
Yvonne
Y
Mihes
Department of Colorectal Surgery, University College Hospital Galway, Galway, Ireland.
Niamh M
NM
Hogan
Department of Gastroenterology, University College Hospital Galway, Galway, Ireland.
Larry
L
Egan
Department of Colorectal Surgery, University College Hospital Galway, Galway, Ireland.
Myles R
MR
Joyce
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000066491:Clinical Decision-Making; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D011183:Postoperative Complications / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D012008:Recurrence