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Use of topical rectal therapy to preserve the rectum in surgery of ulcerative colitis

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Abstract

Colectomy with ileorectal anastomosis was performed in 27 patients affected by ulcerative colitis during the period 1969–1977. In 23 the presence of proctitis required topical rectal therapy to prepare the rectum for ileoproctostomy. Topical use of corticosteroids and sulfasalazine by daily retention enemas caused a regression of proctitis and allowed a safe ileorectal anastomosis. After the surgical procedure, protective treatment of the rectal mucosa was continued for life with minimal dosages of the same drugs by daily enemas. Dexamethasone and 6-methylprednisolone in saline solution proved to be suitable corticosteroids for topical use and produced no undesirable long-term side effects. In some patients the steroids were replaced by sulfasalazine per rectum in a daily maintenance dosage. This method of rectal care after colectomy and ileorectal anastomosis prevented relapses of proctitis and kept the rectal mucosa in good condition during follow-up periods of 1 to 9 years. The safety of the topical treatment is directly related to performance of proctoscopic examinations at regular intervals. Provided these conditions are satisfied, colectomy with ileorectal anastomosis should be the standard surgical treatment of ulcerative proctocolitis.

Résumé

Entre 1969 et 1977, 27 malades souffrant de colite ulcéreuse ont subi une colectomie avec iléo-rectostomie. Dans 23 cas, l'atteinte rectale a exigé une thérapeutique locale préparatoire à l'iléo-rectostomie. L'application locale de corticostéroides et de sulfasalazine par lavements journaliers fait régresser les lésions rectales et permet de réaliser avec sécurité l'anastomose iléo-rectale. Après l'operation, le traitement protecteur de la muqueuse rectale est poursuivi ad vitam avec des doses minimes des mêmes drogues administrées par lavements journaliers. La dexaméthasone et la 6-méthylprednisolone en solution saline sont des corticostéroïdes qui conviennent pour l'administration locale, sans produire à long terme d'effets secondaires indésirables. Chez certains malades, les stéroïdes ont été remplacés par la sulfasalazine en administration locale journalière. Cette méthode de traitement du rectum après colectomie et anastomose iléo-rectale prévient les récidives de proctite et garde la muqueuse rectale en bon état pendant des durées de follow-up de 1 à 9 ans. La sécurité de ce traitement local est conditionnée par des rectoscopies faites à intervalles réguliers. Si ces conditions peuvent être remplies, la colectomie avec anastomose iléo-rectale devrait être le traitement standard de la proctocolite ulcéreuse.

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References

  1. Aylett, S.O.: Ulcerative colitis. Ileorectal anastomosis: review 1952–68. Proc. R. Soc. Med.64:967, 1971

    PubMed  CAS  Google Scholar 

  2. Aylett, S.O.: Cancer and ulcerative colitis. Br. Med. J.1:203, 1971

    Google Scholar 

  3. Hughes, E.S.R.: Ileorectal anastomosis for ulcerative colitis. Dis. Colon Rectum10:35, 1967

    PubMed  CAS  Google Scholar 

  4. Berkovitz, Z.T.: Therapy in ulcerative and granulomatous colitis. In Ulcerative and Granulomatous Colitis, Berkovitz, Z.T., Kirsner, J.B., Lindner, A.E., Marshak, R.H., Menguy, R.B., Sommers, S.C., editors, Springfield, Ill., C.T. Thomas, 1973

    Google Scholar 

  5. Binder, S.C., Miller, H.H., Deterling, R.A.: Emergency and urgent operations for ulcerative colitis. Arch. Surg.110:284, 1975

    PubMed  CAS  Google Scholar 

  6. Brooke, B.N.: In defense of ileostomy. Am. J. Dig. Dis.7:585, 1962

    Article  Google Scholar 

  7. Foglia, R., Ament, M.E., Fleischer, D., Fonkalsrud, E.W.: Surgical management of ulcerative colitis in childhood. Am. J. Surg.134:58, 1977

    Article  PubMed  CAS  Google Scholar 

  8. Lulu, D.J., Dragstedt, L.R., II: Primary total proctocolectomy for ulcerative colitis. Am Surg.40:417, 1974

    PubMed  CAS  Google Scholar 

  9. MacDougall, I.P.M.: The cancer risk in ulcerative colitis. Lancet2:655, 1964

    Article  PubMed  CAS  Google Scholar 

  10. Mayo, C.W., Fly, O.A., Jr., Connelly, M.E.: Fate of the repairing rectal segment after subtotal colectomy for ulcerative colitis. Ann. Surg.144:753, 1956

    PubMed  Google Scholar 

  11. Menguy, R.B.: Surgical treatment and choice of operations in the management of colitis. In Ulcerative and Granulomatous Colitis, Berkovitz, Z.T., Kirsner, J.B., Lindner, A.E., Marshak, R.H., Menguy, R.B., Sommers, S.C., editors, Springfield, Ill., C.T. Thomas, 1973

    Google Scholar 

  12. Moss, G.S., Heddie, N.: Fate of rectal stump in ulcerative colitis. Arch. Surg.91:967, 1965

    PubMed  CAS  Google Scholar 

  13. Ritchie, J.K.: Colectomy and anastomosis for inflammatory bowel disease. Arch. Fr. Mal. App. Dig.63:588, 1974

    PubMed  CAS  Google Scholar 

  14. Truelove, S.C., Lee, E.: The management of ulcerative colitis. In Recent Advances in Surgery, Taylor, S., editor, Edinburgh, Churchill-Livingstone, 1973

    Google Scholar 

  15. Aylett, S.O.: Delayed ileorectal anastomosis in the surgery of ulcerative colitis. Br. J. Surg.57:812, 1970

    PubMed  CAS  Google Scholar 

  16. Bechi, P., Carrà, F., Bicchielli, E.: La terapia chirurgica della colite ulcerosa. Chir. Gastroenterol.11:49, 1977

    Google Scholar 

  17. Fegiz, G.: Chirurgia della colite ulcerosa. Arch. ed Atti della Sol. Ital. di Chir. 74° Congresso, 1972, pp. 591–657

  18. Adson, M.A., Cooperman, A.M., Farrow, G.M.: Ileorectostomy for ulcerative disease of the colon. Arch. Surg.104:424, 1972

    PubMed  CAS  Google Scholar 

  19. Alexander-Williams, J., Steinberg, D.M., Allen, R.N.: Ileorectal anastomosis in Crohn's disease of the large bowel. Arch. Fr. Mal. App. Dig.63:588, 1974

    PubMed  CAS  Google Scholar 

  20. Franchini, A.: La chirurgia in più tempi nelle malattie colorettali. Chir. Gastroenterol.9:411, 1975

    Google Scholar 

  21. Griffen, W.O., Lillehei, R.C., Wangensteen, O.H.: Ileoproctostomy in ulcerative colitis: long-term follow-up, extending in early cases to more than 20 years. Surgery53:705, 1963

    PubMed  Google Scholar 

  22. Jones, P.F., Munro, A., Ewen, S.B.N.: Colectomy and ileorectal anastomosis for colitis: report of a personal series, with a critical review. Br. J. Surg.64:615, 1977

    PubMed  CAS  Google Scholar 

  23. Possati, L.: Considerazioni sulla terapia chirurgica della colite ulcerosa. Minerva Chir.30:401, 1975

    PubMed  CAS  Google Scholar 

  24. Ritchie, J.K.: Colectomy and anastomosis for inflammatory bowel disease. Arch. Fr. Mal. App. Dig.63:588, 1974

    PubMed  CAS  Google Scholar 

  25. Tompkins, R.K., Weinstein, M.H., Foroozan, P., Marx, F.W., Barker, W.F.: Reappraisal of rectum-retaining operations for ulcerative and granulomatous colitis. Am. J. Surg.125:159, 1973

    Article  PubMed  CAS  Google Scholar 

  26. Turnbull, R.B.: The surgical approach to the treatment of inflammatory bowel disease. In Inflammatory Bowel Disease, Kirsner, J.B., Shorter, R.G., editors, Philadelphia, Lea & Febiger, 1975

    Google Scholar 

  27. Veidenheimer, M.C., Nugent, F.W.: Treatment of chronic ulcerative colitis. Surg. Clin. North Am.48:559, 1968

    PubMed  CAS  Google Scholar 

  28. Walker, F.C.: The Surgical Management of Ulcerative Colitis, London, Butterworths, 1969

    Google Scholar 

  29. Watts, J., Hughes, E.S.R.: Ulcerative colitis and Crohn's disease: results after colectomy and ileorectal anastomosis. Br. J. Surg.64:77, 1977

    PubMed  CAS  Google Scholar 

  30. Frey, C.F., Weaver, D.K.: Colectomy in children with ulcerative colitis and granulomatous colitis. Arch. Surg.104:416, 1972

    PubMed  CAS  Google Scholar 

  31. Heberer, G., Hoffmann, K., Bary, S. von: Il trattamento chirurgico delle malattie infiammatoire del colon: colite ulcerosa morbo di Crohn, diverticolite. Minerva Chir.33:631, 1978

    PubMed  CAS  Google Scholar 

  32. Hughes, R.G., Hall, T.J., Block, G.E., Levin, B., Moosa, A.R.: The prognosis of carcinoma of the colon and rectum complicating ulcerative colitis. Surg. Gynecol. Obstet.146:46, 1978

    PubMed  CAS  Google Scholar 

  33. Kirsner, J.B., Wall, A.J.: The medical treatment of ulcerative colitis and Crohn's disease of the colon. In Inflammatory Bowel Disease, Kirsner, J.B., Shorter, R.G., editors, Philadelphia, Lea & Febiger, 1975

    Google Scholar 

  34. Kristensen, M., Koudahl, G., Fischerman, K., Jarnum, K.: High dose prednisone treatment in severe ulcerative colitis. Scand. J. Gastroenterol.9:177, 1974

    PubMed  CAS  Google Scholar 

  35. Veidenheimer, M.C., Nugent, F.W.: Treatment of chronic ulcerative colitis. Surg. Clin. North Am.48:559, 1968

    PubMed  CAS  Google Scholar 

  36. Goldman, P., Peppercorn, M.A.: Sulphasalazine. N. Engl. J. Med.292:20, 1975

    Article  Google Scholar 

  37. Cowan, G.O., Das, K.M., Eastwood, M.A.: Further studies of sulphasalazine metabolism in the treatment of ulcerative colitis. Br. Med. J.2:1057, 1977

    Article  PubMed  CAS  Google Scholar 

  38. Khan, A.K.A., Piris, P., Truelove, S.C.: An experiment to determine the active therapeutic moiety of sulphasalazine. Lancet2:892, 1977

    Article  Google Scholar 

  39. Malolepszky, J., Kuczynska-Sekieta, K., Chavhaj, Wl.: Intal (sodium cromoglycate) therapy in ulcerative colitis. Acta Allergol. (Kbh.) (Suppl.)13:82, 1977

    Google Scholar 

  40. Mani, V., Lloyd, G., Green, F.H.Y., Fox, H., Turnberg, L.A.: Treatment of ulcerative colitis with oral disodium cromoglycate. Lancet1:439, 1973

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University School of Medicine, Milan, Italy

    Luigi Gallone M.D. (Professor of Surgery), Luciano Olmi M.D. & Vincenzo Marchetti M.D.

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  1. Luigi Gallone M.D.
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  2. Luciano Olmi M.D.
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  3. Vincenzo Marchetti M.D.
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Gallone, L., Olmi, L. & Marchetti, V. Use of topical rectal therapy to preserve the rectum in surgery of ulcerative colitis. World J. Surg. 4, 609–613 (1980). https://doi.org/10.1007/BF02401644

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