Reappraisal of rectum-retaining operations for ulcerative and granulomatous colitis

Tompkins, Ronald K.; Weinstein, Mark H.; Foroozan, Parviz; Marx, Frederick W.; Barker, Wiley F.

doi:10.1016/0002-9610(73)90021-4

Cited by 27 publications

(3 citation statements)

References 10 publications

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“…The disadvantage of total colectomy as opposed to panproctocolectomy lies in the retained rectum. In the majority of cases of toxic megacolon, persistance of proctitis necessitates delayed resection of the rectum 32,33,34,35 but hopefully the patient may then be better able to withstand abdominoperineal resection. For the remaining patients retention of the rectum does offer the possibility of delayed ileorectal anastomosis 36,37,38,39 .…”

Section: Discussionmentioning

confidence: 99%

Management of Toxic Megacolon

Chare

Aubrey

1982

Int J Clinical Practice

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Toxic megacolon is a rare complication of ulcerative colitis; this report describes 8 patients, 4 of whom died. The high mortality was attributable to prolonged medical treatment, delay in recognising the need to undertake surgery and colonic perforation. Our findings suggest that steroids have no place in the management of this condition; rather the occurrence of toxic megacolon should be regarded as an absolute indication for surgery with patients being selected for either total colectomy or pan-proctocolectomy.

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Section: Discussionmentioning

confidence: 99%

Management of Toxic Megacolon

Chare

Aubrey

1982

Int J Clinical Practice

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“…Both conditions are affected by antiinflammatory drugs, and the indications for surgery are the same in both. In fact, total abdominal colectomy has been advocated by several surgeons as the most suitable treatment for Crohn's colitis, with preservation of the rectum, provided it is not affected by the ulcerogranulomatous lesions [4,11,18,25,29,30].…”

Section: Patient Materials and Methodsmentioning

confidence: 99%

“…Although the symptoms of proctitis sometimes decrease, the ulcers and polypoid vegetations usually remain and sometimes become worse when the ileoproctostomy is performed. The literature contains numerous reports of cases in which it was necessary to convert the ileoproctostomy to a permanent ileostomy with removal of the rectal stump [11, [18][19][20][21][22][23][24][25][26][27][28][29]. Moreover, persistence of disease in the rectum increases the danger of postoperative peritonitis due to leakage from the ileorectal anastomosis [18,19,22,27].…”

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confidence: 99%

Use of topical rectal therapy to preserve the rectum in surgery of ulcerative colitis

1980

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Colectomy with ileorectal anastomosis was performed in 27 patients affected by ulcerative colitis during the period 1969-1977. In 23 the presence of proctitis required topical rectal therapy to prepare the rectum for ileoproctostomy. Topical use of corticosteroids and suffasalazine by daily retention enemas caused a regression of proctitis and allowed a safe ileorectal anastomosis. After the surgical procedure, protective treatment of the rectal mucosa was continued for life with minimal dosages of the same drugs by dally enemas. Dexamethas0ne and 6--methylprednisolone in saline solution proved to be suitable corticosteroids for topical use and produced no undesirable long-term side effects. In some patients the steroids were replaced by sulfasalazine per rectum in a daily maintenance dosage. This method of rectal care after colectomy and ileorectal anastomosis prevented relapses of proctitis and kept the rectal mucosa in good condition during follow-up periods of I to 9 years. The safety of the topical treatment is directly related to performance of proctoscopic examinations at regular intervals. Provided these conditions are satisfied, colectomy with ileorectal anastomosis should be the standard surgical treatment of ulcerative proctocolitis.

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