Total colectomy and endorectal ileal pull-through with internal ileal reservoir for ulcerative colitis
Fonkalsrud, E.W.
Surgery Gynecology and Obstetrics 150(1): 1-8
1980
ISSN/ISBN: 0039-6087 PMID: 7350695 Document Number: 167698
During the past 2 yr, an internal ileal reservoir following total colectomy, mucosal proctectomy and endorectal ileal pull-through with ileoanal anastomosis was constructed in 5 patients who had chronic ulcerative colitis. A diverting ileostomy and transcutaneous reservoir catheter for irrigation helped to reduce the incidence of complications. Each of the patients is alive and 2 patients have undergone closure of the ileal stoma. While these patients had from 4 to 12 stools daily, the number decreases as the postoperative time lengthens and with their regular use of Metamucil. In each instance, the patient has achieved anorectal continence and the ability to discriminate fluid from air. One patient with severe schizophrenia failed to manage the ileal reservoir catheter, developed stasis, infection and underwent resection of the reservoir 4 mo. after closure of the ileal stoma. In another patient, who had a flare-up of inflammation in the remaining rectal mucosa before closure of the ileal stoma, the ileoanal anastomosis separated and it was treated by converting the reservoir to a modified Kock pouch with a cutaneous nipple valve ileostomy. Two patients are awaiting closure of the ileal stoma. Three patients with moderate to severe rectal inflammation were deemed unsuitable for an ileal pull-through procedure because of injury to the anorectal sphincter mechanism during removal of the mucosa. Those who have moderate to severe rectal disease do not appear to be appropriate candidates for the pull-through operation, despite the preoperative use of steroid therapy and parenteral nutrition. Further clinical trial in selected patients is warranted.