Pull-through with isolated jejunal loop for ulcerative colitis.

Total colectomy with endorectal mucosectomy and ileal pull-through to preserve fecal continence is well known for ulcerative colitis. A female patient developed severe ulcerative colitis at 5 years of age and had an emergency subtotal colectomy and ileostomy at 7 years of age. The rectum was preserved. At 9 years of age rectal mucosectomy and a pull-through using isolated jejunal loop were performed. Postoperatively she was treated with ano-rectal physiotherapy and balloon dilatations of the new rectum. Six months later the ileostomy was closed. Two and a half years after her operation she has 2-4 soft bowel movements daily, perfect diurnal control with occasional night soiling. A pull-through using an isolated loop of jejunum leaves intact a good functioning ileostomy. The blood supply to the jejunum is better than the terminal ileum. Bacterial contamination with jejunum is less than with ileum. There is no need for a reservoir; if the pull-through fails valuable terminal ileum is not lost.