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

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.

P227 Timing of acute severe colitis in the course of an inflammatory bowel disease: is it a prognostic factor?

Background In this study, we aimed to compare outcomes of patients with a severe acute colitis (SAC) inaugurating their inflammatory bowel disease (IBD) with SAC occurring in those with Known diagnosis of IBD. Methods We conducted a retrospective chart review of patients who were admitted to our unit for severe acute colitis over 7 years. Demographics, characteristics of the disease, clinical presentation, laboratory, morphologic investigations, treatments and outcomes were reviewed from medical records. Patients were divided in two groups: SAC inaugurating IBD (A) and SAC occurring during the course of Known IBD (B) and compared in terms of clinical presentation, response to medical treatment and colectomy rate. Statistical analysis was performed with SPSS software version 19. Results A total of 62 patients were colliged (23 males and 39 females). Mean age at the onset of SAC was 36 years (14–78 years). There were 34 patients of group (A) and 28 patients of group (B). Overall, there were 28 patients with Crohn’s disease, 31 patients with UC and 3 others with indetermined colitis. There were no differences between both of the groups with regard to sex, age at the onset of SAC, smoking status, family history of IBD, body mass index and laboratory findings including full blood count and C reactive protein. Mean Truelove–Witts score was higher in group A vs group B (4 Vs 3, p<0.0001). Erythrocyte sedimentation rate was slightly higher in group A than group B (68 Vs 53, p=0.07). Overall, endoscopic signs of severity were significantly more common in patients from group A vs group B: deep colonic ulcerations (p=0.05) and diffuse mucosal abrasions (p=0.04). Patients from group B seem to respond better to steroid therapy than patients from group A (68% Vs 58%, p=0.5). There was no difference between both of the groups with regard to use of cyclosporine, colectomy, and recurrence of SAC. Conclusion Patients with severe acute colitis inaugurating their IBD seemed to have more severe clinical presentation than in those followed for IBD and complicated by SAC. However, response to therapy and need for colectomy are similar in both groups.

N17 Profile of ostomy patients treated at a referral hospital for inflammatory bowel disease

Background As part of the surgical treatment of inflammatory bowel disease (IBD), sometimes is necessary the intestinal stoma. The aim of this study is to identify the profile of ostomy patients treated at a referral public hospital in IBD in Brazil. Methods This is a descriptive study with a quantitative approach. The sample consisted of all patients who underwent stoma surgery at a referral public hospital in IBD in Brazil. The inclusion criteria were: to have a medical diagnosis of Crohn’s Disease (CD) or Ulcerative Colitis (UC) and to have or have had intestinal stoma. Data collection was performed through the analysis of patient records. Results The number of patients attending the outpatient clinic is approximately 200 with UC and 150 with DC. The sample consisted of 33 patients, the majority of male gender (51.52%), age between 22 to 77 years (44.55 ± 15.10), literate (93.94%), self-declared white (84.85%), coming from the state of São Paulo (96.97%), smokers (6.06%), alcoholics (3.03%), married (63.64%) and the number of children ranged from 01 to 10. Regarding the characteristics related to IBD, 15 (45.45%) were diagnosed with CD, 6 (40%) were fistulising ileocolonic type and 18 (54.55%) were diagnosed with UC and most with pancolitis (88.89%). The average time of illness was 14.2 years. Among the causes of the stoma, the most frequent were perforating acute abdomen (n = 5, 15.15%), severe acute colitis (n = 4, 12.12%), obstructive acute abdomen (n = 4, 12.12%), toxic megacolon. (n = 3, 9.09%) and neoplasia (n = 2, 6.06%). Regarding the character of the surgery, 10 (30.30%) were urgency and emergency and 11 (33.33%) elective. Only 5 (15.15%) surgeries performed the previous demarcation of the stoma. Regarding the types of stoma, 4 (12.12%) had temporary colostomy and 3 (9.09%) permanent, 16 (48.48%) had temporary ileostomy and 3 (9.09%) permanent. The average time of stoma was 3.19 years. 2 (6.06%) colostomised and 9 (27.27%) ileostomised reversed the stoma. 2 (6.06%) patients refused intestinal reconstruction. Conclusion The study results showed us that IBD with more severe extension and behaviour can result in intestinal ostomy, either temporary or permanent. The characterisation of ostomised patients is necessary for the identification of nursing needs to be highlighted, such as the previous demarcation of the stoma.