RESTORATIVE PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS FOR SEVERE ULCERATIVE COLITIS IN RURAL NEPAL
For most patients with ulcerative colitis (UC) requiring surgery, restorative proctocolectomy (RP) may bethe operation of choice. By using an ileal pouch-anal anastomosis, it offers a curative operation with no needfor a permanent ileostomy. We present a 16 year-old boy from a remote village with chronic UC whichfailed to respond satisfactorily to maximal medical therapy. We opted for elective surgery because he wasunlikely to comply with long-term medical therapy and surveillance, nor to survive if he came to emergencysurgery in our setting. RP was performed and he recovered well. His bowel habit was better than the 5 or 6motions per day that is typical following this procedure. Where the expertise is available, the operation canbe performed and any complications managed, using only the basic facilities available in most districthospitals. We present this case as an example of the “one-hit medicine” approach that is often required inour context. We suggest that RP may occasionally be indicated for UC in rural Nepal, where the alternativescarry relatively greater disadvantages.Key Words: Restorative proctocolectomy, ileal pouch-anal anastomosis,ulcerative colitis, appropriate technology.