Sixty-nine patients who underwent total
colectomy and end
ileostomy with an oversewn rectal stump for
Crohn disease between 1962 and 1997 were reviewed. Postoperative complications, fate of the rectum or small-bowel recurrence, factors affecting complications and recurrence rates, and risk of rectal
carcinoma are discussed.
RESULTS: Fourteen patients had an emergency
colectomy. There were no operative or postoperative deaths. In all except five patients symptoms were rapidly relieved. The commonest postoperative complication was an intra-abdominal
sepsis (12%). Only five patients (7%) underwent ileorectal anastomosis, of whom two required
proctectomy later. Overall, 37 patients (54%) required
proctectomy, with a median duration of 2 years. Sixteen patients (23%) developed small-bowel recurrence requiring surgery, with a median duration of 6.8 years. None of the following factors affected the
proctectomy rate: sex, age at operation, duration of symptoms, smoking, perforating disease, coexisting small-bowel disease, preoperative
proctitis, perianal disease, emergency operation, postoperative complications, or medical treatment. Youth was the only factor associated with a significantly higher reoperation rate for small-bowel recurrence. One patient developed an
adenocarcinoma in a
rectovaginal fistula, which was curatively resected at
proctectomy.
CONCLUSIONS: Total
colectomy and end
ileostomy is a safe and effective procedure. However, a few patients underwent ileorectal anastomosis, and half of the patients required
proctectomy. The small-bowel recurrence rate is low. Regular surveillance of the retained rectum is advised because of a small
cancer risk.