Total Colectomy with an Ileorectal Anastomosis: Perforation of Distal Portion of the Terminal Ileum

Abstract

Total colectomy followed by ileorectal anastomosis is an established operation that may be employed as a surgical solution for a variety of colonic diseases. Postoperative morbidity and mortality rates are generally regarded as low, and functional outcome is rated as good to excellent by most patients. The ileorectal anastomosis is usually latero-terminal and is constructed with staples. If the segment of terminal ileum extending past the site of the anastomosis is too long, it remains as an appendage, and this portion of bowel may fold or twist upon itself, thus creating an intermittent closed-loop obstruction of its tip, leading to localized perforation, sepsis, and eventual fistula formation. The case of one patient who developed significant complications arising from this portion of the bowel is reported.