Septic complications after total colectomy, excision of the rectal mucosa ileoanastomy and its prevention--with special reference to pelvic sepsis
Okamura, T.
Nihon Geka Gakkai Zasshi 84(5): 437-451
1983
ISSN/ISBN: 0301-4894 PMID: 6674805 Document Number: 220858
Forty-two patients had total colectomy, excision of th rectal mucosa and ileoanastomy for adenomatosis coli or ulcerative colitis. The essential operative management for prevention of pelvic sepsis are 1) intraoperative bowel irrigation with antimicrobes, 2) creation of temporary defunctioning ileostomy, 3) effective drainage of the rectal cuff. With these methods pelvic sepsis developed in ten out of forty contaminated case. Whereas in one contaminated case both pelvic sepsis and wound infection developed. Age of the patients, the presence of underlying diseases, type of reservoir and surgeon's experience had no correlation with the incidence of pelvic sepsis, however the short rectal cuff seemed significant for its prevention. The stenosis of the transposed ileum had developed in two cases, one of which case had recurrence of pelvic sepsis after closure of ileostomy. One patient had chronic fistula between transposed ileum and perineum after removal of the transperineal drainage. These complications are very difficult to manage. Three patients had closure of ileostomy with satisfactory result. Proctoscopic examination were essential to identify with anastomotic break down and pus discharge. Irrigation of the transposed ileum with antimicrobes for aerobes and anaerobes should be started after diagnosis. Incision and drainage were necessary when irrigation failed to heal cuff abscess.