EP.TU.688The fate of the rectal stump following subtotal colectomy for acute colitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
James Lucocq ◽  
Darren Porter ◽  
Girivasan Muthukumarasamy
Keyword(s):  
Medical Therapy ◽  
Subtotal Colectomy ◽  
Standard Procedure ◽  
Rectal Stump ◽  
Laparoscopic Approach ◽  
Fulminant Colitis ◽  
Acute Colitis ◽  
Severe Acute Colitis ◽  
Mucous Fistula ◽  
Severe Colitis

Abstract Aims Acute severe colitis requires surgery in approximately thirty percent of cases. Subtotal colectomy with end ileostomy is the standard procedure with distinct advantages to a laparoscopic approach. Controversy surrounds the optimal short and long-term management of the distal rectal stump. This study reviews the clinical outcomes and the fate of the rectal stump in this patient cohort. Methods Analysis of prospective data of patients who underwent emergency subtotal colectomy for severe acute colitis between 2010 and 2020 in a tertiary referral centre. Results Sixty-six patients underwent subtotal colectomy (median age, 40years; M:F, 1.3:1). Subtotal colectomy was performed for failure of medical therapy during an acute episode of severe colitis (56%), for fulminant colitis (40%), or for colonic strictures (4%). In 98% percent of patients the rectal stump was closed at the level of the recto-sigmoid junction and in 2% a mucous fistula was formed. 73% of patients opted for no further surgery, but 27% underwent a completion proctectomy, most commonly performed because of rectal stump bleeding. The median follow-up was 6.25years, during which 17% of those with a completion proctectomy underwent an ileo-pouch anal anastomosis (IPAA). Conclusions Subtotal colectomy with closed rectal intra-peritoneal stump and end ileostomy is the procedure of choice in severe acute colitis refractory to maximal medical therapy or fulminant colitis. Given the patient dissatisfaction and morbidity associated with mucous fistula, this procedure should be abandoned. Pelvic dissection should not be performed at the time of the emergency subtotal colectomy given the risk of morbidity.

Subtotal colectomy for severe acute colitis: a 20-year experience of a tertiary care center with an aggressive and early surgical policy

2003 ◽  
Vol 197 (3) ◽  
pp. 379-385 ◽  
Author(s):  
Arnaud Alves ◽  
Yves Panis ◽  
Yoram Bouhnik ◽  
Vincent Maylin ◽  
Anne Lavergne-Slove ◽  
...  
Keyword(s):  
Subtotal Colectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Acute Colitis ◽  
Severe Acute Colitis

Rectal Stump Management After Subtotal Colectomy for Severe Colitis, In or Out? A Retrospective Cohort Study

2020 ◽  
Vol 82 (4) ◽  
pp. 585-591
Author(s):  
Sergei Bedrikovetski ◽  
Jianliang Liu ◽  
Nagendra N. Dudi-Venkata ◽  
Hidde M. Kroon ◽  
Mark Lewis ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Subtotal Colectomy ◽  
Rectal Stump ◽  
Severe Colitis

scholarly journals Surgical Site Infection and Validity of Staged Surgical Procedure in Emergent/Urgent Surgery for Ulcerative Colitis

2013 ◽  
Vol 98 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Motoi Uchino ◽  
Hiroki Ikeuchi ◽  
Hiroki Matsuoka ◽  
Yoshiko Takahashi ◽  
Naohiro Tomita ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Risk Factor ◽  
Surgical Site Infection ◽  
Restorative Proctocolectomy ◽  
Odds Ratio ◽  
Standard Procedure ◽  
Univariate Analysis ◽  
Site Infection ◽  
Wound Class ◽  
Mucous Fistula

Abstract Although restorative proctocolectomy is recognized as a standard procedure for ulcerative colitis, infectious complications after surgery cannot be disregarded. The aim of this study was to define predictors of surgical site infection (SSI) in urgent/emergent surgery for ulcerative colitis. We performed prospective SSI surveillance for 90 consecutive patients. Possible risk factors were analyzed by logistic regression analyses. Incidences of incisional SSI (i-SSI) and organ/space SSI were 31.1% and 6.9%, respectively, and increased significantly with higher wound class (P < 0.01). Multivariate analysis showed wound class ≥3 as an independent risk factor for i-SSI. In univariate analysis, although the mucous fistula procedure was a risk factor for i-SSI (odds ratio, 3.45; P < 0.01), Hartmann procedure also represented a risk factor for o-SSI (odds ratio, 12.8; P < 0.01). Urgent restorative proctocolectomy for patients without high wound class and emergent total colectomy with mucous fistula for patients with high wound class appear to represent feasible options.

scholarly journals An Alternative Approach to the Terminal Management of Ogilvie Syndrome

2017 ◽  
Vol 11 (2) ◽  
pp. 352-358
Author(s):  
Daniel Galban ◽  
Joshua J. Baiel
Keyword(s):  
Quality Of Life ◽  
Surgical Resection ◽  
Medical Therapy ◽  
Subtotal Colectomy ◽  
Abdominal Discomfort ◽  
Conservative Approach ◽  
Replacement Surgery ◽  
Alternative Approach ◽  
Ogilvie Syndrome

Ogilvie syndrome is defined as colonic pseudo-obstruction due to nonmechanical causes. Mortality of nearly 50% is associated with perforation of the distended, pseudo-obstructed colon. While conservative medical therapy has proven to be beneficial in a majority of cases, >3% of patients have significant distention or perforation of the colon that warrants surgical resection. The case of a 48-year-old male with progressive abdominal discomfort and distention 12 days following knee replacement surgery is presented. He was subsequently diagnosed with colonic pseudo-obstruction and definitively treated with subtotal colectomy and colostomy. We propose that a more conservative approach to treatment of colonic pseudo-obstruction may prevent the need for colostomy, significantly improving quality of life.

scholarly journals Emergency subtotal colectomy for fulminant Clostridium difficile colitis – is a surgical solution considered for all patients?

2010 ◽  
Vol 92 (1) ◽  
pp. 56-60 ◽  
Author(s):  
K Gash ◽  
E Brown ◽  
A Pullyblank
Keyword(s):  
Clostridium Difficile ◽  
Subtotal Colectomy ◽  
Postoperative Mortality ◽  
Antibiotic Use ◽  
Morbidity And Mortality ◽  
Fulminant Colitis ◽  
Surgical Morbidity ◽  
Predisposing Factor ◽  
Number Of Patients ◽  
Neurosurgical Patients

INTRODUCTION Clostridium difficile has been an increasing problem in UK hospitals. At the time of this study, there was a high incidence of C. difficile within our trust and a number of patients developed acute fulminant colitis requiring subtotal colectomy. We review a series of colectomies for C. difficile, examining the associated morbidity and mortality and the factors that predispose to acute fulminant colitis. PATIENTS AND METHODS This is a retrospective study of patients undergoing subtotal colectomy for C. difficile colitis in an NHS trust over 18 months. Case notes were reviewed for antibiotic use, duration of diarrhoea, treatment, blood results, pre-operative imaging and surgical morbidity and mortality. RESULTS A total of 1398 patients tested positive for C. difficile in this period. Of these, 18 (1.29%) underwent colectomy. All were emergency admissions, 35% medical, 35% surgical, 24% neurosurgical and 6% orthopaedic. In the cohort, 29% were aged less than 65 years. Patients had a median of three antibiotics (range, 1–6), for a median of 10 days (range, 0–59 days). Median length of stay prior to C. difficile diagnosis was 13 days. Subtotal colectomy was performed a median of 4 days (range, 0–23 days) after diagnosis. Postoperative mortality was 53% (9 of 17). The median C-reactive protein level for those who died was 302 mg/l, in contrast to 214 mg/l in the survival group. Whilst 62% of all C. difficile cases were medical, the colectomy rate was only 0.7%. In the surgical specialties, the colectomy rates were 3.2% for general surgical, 1.2% for orthopaedic and 8% for neurosurgical patients. CONCLUSIONS Colectomy for C. difficile colitis has a high mortality but can be life-saving, even in extremely sick patients. Although heavy antibiotic use is a predisposing factor, this is not an obligatory prerequisite in the development of C. difficile. Neither is it a disease of the elderly, making it difficult to predict vulnerable patients. There are large differences in colectomy rates between specialties and we suggest there may be a place for a surgical opinion in all cases of severe C. difficile colitis.

Laparoscopic Hepatectomy for Liver Cancer

2015 ◽  
Vol 33 (5) ◽  
pp. 691-698 ◽  
Author(s):  
Akishige Kanazawa ◽  
Tadashi Tsukamoto ◽  
Sadatoshi Shimizu ◽  
Satoshi Yamamoto ◽  
Akihiro Murata ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Standard Procedure ◽  
Laparoscopic Hepatectomy ◽  
Surgical Techniques ◽  
Laparoscopic Approach ◽  
Technological Innovations ◽  
Rapid Progress ◽  
Hepatic Surgery ◽  
Novel Approach ◽  
Near Future

This chapter covers a range of important topics of laparoscopic hepatectomy as a novel approach toward treatment of liver cancer. Although laparoscopic hepatectomy was performed in a limited number of centers in the 1990s, technological innovations, improvements in surgical techniques and accumulation of experience by surgeons have led to more rapid progress in laparoscopic hepatectomy in the late 2000s for minimally invasive hepatic surgery. Currently, laparoscopic hepatectomy can be performed for all tumor locations and several diseases via several approaches. The laparoscopic approach can be applied to several types of resection, not only for tumors but also for liver transplantation, with equivalent or better results compared with those obtained with open surgery. Therefore, laparoscopic hepatectomy will become a standard procedure for treatment of liver cancer in the near future.

Colectomy for acute colitis: is it safe to close the rectal stump?

1995 ◽  
Vol 10 (4) ◽  
pp. 222-224 ◽  
Author(s):  
R. F. McKee ◽  
R. A. Keenan ◽  
A. Munro
Keyword(s):  
Rectal Stump ◽  
Acute Colitis

scholarly journals The Handling of the Rectal Stump Does Not Affect Severe Morbidity After Subtotal Colectomy For Ulcerative Colitis: A Retrospective Cohort Study

2019 ◽  
Vol 109 (3) ◽  
pp. 238-243
Author(s):  
M. Lissel ◽  
S. Omidy ◽  
P. Myrelid ◽  
M. Block ◽  
E. Angenete
Keyword(s):  
Risk Factors ◽  
Ulcerative Colitis ◽  
Body Mass Index ◽  
Emergency Surgery ◽  
Retrospective Cohort ◽  
Subtotal Colectomy ◽  
Rectal Stump ◽  
Aminosalicylic Acid ◽  
Severe Morbidity ◽  
Preoperative Medication

Background and Aims: Colectomy due to ulcerative colitis is associated with complications. One severe complication is the risk for blow-out of the remaining rectal remnant. The aim of this study was to compare the frequency and severity of complications in patients with the rectal remnant left subcutaneously versus patients with the rectal remnant left intra-abdominally. A secondary aim was to identify risk factors for complications. Materials and Methods: Consecutive patients at two tertiary centers in Sweden were retrospectively reviewed regarding surgical procedures; complications classified according to Clavien–Dindo; and possible risk factors for complications such as preoperative medication, emergency surgery, and body mass index. Results: 307 patients were identified. Minor complications were more common than previously reported (85%–89%). Severe surgical complications were not related to the handling of the rectal remnant. Leaving the rectal remnant subcutaneously was associated with local wound problems. Risk factors for severe complications were emergency surgery and preoperative medication with 5-aminosalicylic acid. Conclusion: Minor complications after colectomy for ulcerative colitis are very common and need to be addressed. Leaving the rectal stump intra-abdominally seems safe and may be advantageous to reduce local wound morbidity.

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