SURGICAL MANAGEMENT OF ULCERATIVE COLITIS

Surgical treatment becomes necessary in a certain number of patients with ulcerative colitis who do not respond to medical management. The operation of low ileorectal anastomosis here described is done a year or more after subtotal colectomy and ileostomy. It consists in mobilizing the rectum, excising part of the rectum with the sigmoid colon, and making an end-to-side anastomosis of ileum to the remaining part of the rectum. During the first few weeks after the second stage, frequent defecations caused considerable disability, but this generally subsided. In 13 patients rectal continence was attained after the first several defecations after the ileoproctostomy; in the remaining one patient incontinence persisted because the sphincter had been damaged by years of preoperative disease. In all cases the anastomosis healed without formation of abscess or fistula. This operation should be considered whenever the rectum and its sphincter mechanism have escaped serious damage, since it offers the hope of avoiding a permanent ileostomy.