Function and quality of life results after ileal pouch surgery for chronic ulcerative colitis and familial polyposis

Article Abstract:

Intestinal function and quality of life, including occupational, social, and sexual function, was assessed in 75 patients who underwent construction of a pelvic pouch from tissues of the lining of the abdomen following surgery to relieve ulcerative colitis or inherited polyps of the colon (last section of the large intestine). An ileostomy, a surgical opening which connects the small intestine to the outside body wall, often combined with the removal of a segment of large intestine, was part of the initial procedure for all 75 patients. A second surgical procedure closed the ileostomy opening and created a pouch connecting the small intestine with the rectal anal opening. Complications occurred in 45 percent of patients after construction of the pouch, and in 17 percent after closing the ileostomy, with the most common complication (22 percent of cases) being a constriction between the pouch and the anus (opening through which feces is expelled). The complication with the greatest potential for causing disease was splitting of the surgical joint between the pouch and the anus. This occurred in 8 percent of cases and was a good indication that the pouch was likely to fail. Fifty-eight patients with successful intestinal continuity were followed during the three-month period immediately after the second procedure and 52 patients were assessed again between four and 26 months after the procedure with regard to quality of life. Overall, 94 percent of all patients with restored intestinal continuity, (73 percent of the entire group), rated the pouch as being superior to the creation of a permanent ileostomy and 92 percent would go through another pouch procedure. These results support the continued use of this procedure as an alternative to a permanent ileostomy in patients suffering from ulcerous colitis or from familiar polyposis.

Intestinal polyps

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Management of severe hemorrhage in ulcerative colitis

Article Abstract:

Ulcerative colitis, a chronic, inflammatory condition affecting the colon, leads to bloody diarrhea in most cases, but hemorrhage is rare. When it does occur, emergency surgery is necessary, and total proctocolectomy (removal of the colon and rectum) is often necessary. Subtotal colectomy (removal of the colon, leaving the rectum) may also be an effective way to treat colitis patients with hemorrhage. This was evaluated by reviewing records from 26 patients, who were either admitted with hemorrhage or who developed one. The average age at the onset of colitis was 25.4 years, and at the time of hemorrhage, 28 years. One patient in the group died due to infection following a perforated duodenal (small intestine) ulcer, and three were managed without surgery. Of the remaining 22 patients, emergency surgery was performed for 11, and 11 underwent semi-elective procedures. Total proctocolectomy was performed on five patients, with ileostomy (surgical creation of an opening through which the intestinal contents drain) for four, and ileo-anal anastomosis (connection of the small intestine to the anus) for one. The remaining 17 patients had subtotal procedures, most of which were done on an emergency basis. Of the patients with subtotal colectomy, 14 required subsequent surgery; seven of these procedures were planned at the time of the first operation. The four patients with intact rectums were alive and well at follow-up. Overall, it appears that subtotal colectomy can be performed in ulcerative colitis patients with massive hemorrhage when subsequent ileo-anal anastomosis is planned. The risk of continued rectal hemorrhage, however, is approximately 12 percent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Hemorrhage, Colon, Colectomy

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Reconstruction of malfunctioning ileoanal pouch procedures as an alternative to permanent ileostomy

Article Abstract:

Within the last 10 years, patients with ulcerative colitis (inflammation of the colon) that was unresponsive to medical treatment, and patients with familial polyposis of the colon have been able to avoid the unpleasantness of an ileostomy (artificial anus on the abdominal wall) and a closed-off rectum. The new, alternative procedure, called an endorectal pullthrough (ERP) procedure, removes the colon (large intestine) but creates an internal pouch for feces using the ileum (lower small intestine). The ileum is then pulled through and connected to the rectum. This procedure produced good results during the first year, but there is little information on long-term follow-up. Recently there have been reports of symptoms severe enough to require pouch removal and creation of a permanent ileostomy. It appears that the ileum is not able to store feces for long periods of time (the way the colon can) without developing chronic inflammation of the mucosa, referred to as pouchitis. Thirteen years experience with this procedure are reviewed; 290 patients underwent ERP at one medical center. Of the first 111 patients to undergo ERP, five developed symptoms severe enough to require ileostomy. But during the last five years, an increasingly aggressive surgical approach was employed. This aggressive approach has resulted in only four of the last 246 consecutive ERP patients having symptoms severe enough to warrant ileostomy. Important elements of this newer approach include: a short rectal muscle cuff; a small reservoir; a short ileal spout; and aggressive correction of rectal narrowing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Prevention, Ileum, Colon surgery

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