Ileorectal anastomosis in ulcerative colitis. Results in 27 patients.

Abstract

Hr: PAST rzw DECADES have brought many changes in the surgical treatment of ulcerative colitis. At one time appendicostomy and cecostomy were performed to permit antiseptics, such as Dakin's solution, and mercurial solutions, to be flushed through the inflamed colon. Later, ileostomy, to "put the colon at rest'"by diverting the fecal stream, was preferred. When many patients continued to have active disease in the colon and acute toxic flareups of ulcerative colitis despite ileostomy, most surgeons advised that after ileostomy colectomy be performed when the patient's condition had improved. However, many patients waited for further surgery until an acute toxic flareup had occurred, and such operations had a high mortality. /leostomy alone in the patient in an acutely toxic condition was found to have a high mortality--of 2'4-66 per cenO, ~ or more. From the reports of results of ileostomy alone for ulcerative colitis it became evident that this operation did not "put the colon at rest," cure the disease, or prevent subsequent complications and acute flareups. We observed that carcinomas developed in patients with ileostomies; and in one patient, a carcinoma actually extended through the ileostomy stoma, z The next improvement in surgical therapy for ulcerative colitis was the practice of performing ileostomy and subtotal colectorny at the same time in the patient in an acutely toxic condition. Ferguson and Stevens 4 stated: "The patients are too sick not to be operated upon." Crile and Thomas -° stated: "Removal of the colon, as completely, and as quickly as possible, appears to be the safest method of treating patients with acute toxic ulcerative colitis." Crile and Thomas -° reported one death in 7 such patients subjeered to subtotal colectomy, an improvement over the mortality in patients receiving medical treatment for the condition and an improvement over the mortality in those treated surgically by ileostomy alone.