OBJECTIVE: To identify the preferred surgical management of the rectal stump after emergency subtotal colectomy (ESC) for acute severe colitis by assessing the morbidity associated with each option. PATIENTS AND METHODS: Consecutive patients undergoing ESC at a district general hospital between 1999 and 2004 were retrospectively audited for pathology, rectal stump complications and length of postoperative hospital stay (POS). RESULTS: Thirty-seven ESCs were performed, 34 were undertaken for disease refractory to medical treatment, 2 for toxic mega colon and 1 for perforation. Thirty-four cases were for ulcerative colitis, 2 Crohn's colitis and 1 infective colitis. Twenty-seven had an intraperitoneal and 10 a subcutaneously placed closed rectal stump. The median POS for patients with a subcutaneously placed stump was shorter than for those with an intraperitoneal stump, 8 and 15 days, respectively (P = 0.04). Two patients had leakage from an intraperitoneal stump, prolonging POS (33 and 193 days). Three of the subcutaneous stumps leaked causing wound infection but not prolonging the POS (6, 7 and 16 days). CONCLUSION: Avoiding a second stoma by closing the rectal stump after ESC has been confirmed as acceptable practice by studies over the last 15 years, reporting no overall increase in complications. The location of a closed rectal stump appears to influence the incidence of pelvic sepsis. The lowest pelvic sepsis rate is associated with subcutaneous placement; despite a higher wound infection rate this option appears to be associated with a lower total morbidity reflected in a shorter POS.
OBJECTIVE: To identify the preferred surgical management of the rectal stump after emergency subtotal colectomy (ESC) for acute severe colitis by assessing the morbidity associated with each option. PATIENTS AND METHODS: Consecutive patients undergoing ESC at a district general hospital between 1999 and 2004 were retrospectively audited for pathology, rectal stump complications and length of postoperative hospital stay (POS). RESULTS: Thirty-seven ESCs were performed, 34 were undertaken for disease refractory to medical treatment, 2 for toxic mega colon and 1 for perforation. Thirty-four cases were for ulcerative colitis, 2 Crohn's colitis and 1 infective colitis. Twenty-seven had an intraperitoneal and 10 a subcutaneously placed closed rectal stump. The median POS for patients with a subcutaneously placed stump was shorter than for those with an intraperitoneal stump, 8 and 15 days, respectively (P = 0.04). Two patients had leakage from an intraperitoneal stump, prolonging POS (33 and 193 days). Three of the subcutaneous stumps leaked causing wound infection but not prolonging the POS (6, 7 and 16 days). CONCLUSION: Avoiding a second stoma by closing the rectal stump after ESC has been confirmed as acceptable practice by studies over the last 15 years, reporting no overall increase in complications. The location of a closed rectal stump appears to influence the incidence of pelvic sepsis. The lowest pelvic sepsis rate is associated with subcutaneous placement; despite a higher wound infection rate this option appears to be associated with a lower total morbidity reflected in a shorter POS.
Authors: P H E Teeuwen; M W J Stommel; A J A Bremers; G J van der Wilt; D J de Jong; R P Bleichrodt Journal: J Gastrointest Surg Date: 2009-01-09 Impact factor: 3.452
Authors: C Schineis; K S Lehmann; J C Lauscher; K Beyer; L Hartmann; G A Margonis; J Michel; C E Degro; F N Loch; F Speichinger; M E Kreis; C Kamphues Journal: Int J Colorectal Dis Date: 2019-12-21 Impact factor: 2.571
Authors: James Wt Toh; Peter Stewart; Matthew Jfx Rickard; Rupert Leong; Nelson Wang; Christopher J Young Journal: World J Gastroenterol Date: 2016-10-28 Impact factor: 5.742
Authors: Chang Hwan Choi; Won Moon; You Sun Kim; Eun Soo Kim; Bo-In Lee; Yunho Jung; Yong Sik Yoon; Heeyoung Lee; Dong Il Park; Dong Soo Han Journal: Intest Res Date: 2017-01-31