A Case of Intractable Crohn's Disease Getting an Excellent Life by Undergoing Rectal Amputation

Yukio Mikami, Mikio Imamura and Hidemi Yamauchi

Department of Surgery, National Sendai Hospital

A 27-year-old man who underwent rectal amputation as the final choice of treatment is reported. He had undergone intestinal resection twice. First, in 1982, subtotal colectomy with ascendicosigmoidostomy was performed for colonic stenosis. Thereafter, he had been treated with SASP. In 1987, he underwent surgery again due to stenosis of the previous anastomotic site. Resection of the anastomotic site with ileoproctostomy was performed. He began to suffer from intractable perianal fistulas accompanied by rectal stenosis in 1993. Seton treatment was performed several times for these perianal fistulas. Barium enema, which was done in October 1996, showed marked rectal stenosis, an ileoileal fistula, and stenosis of the previous anastomotic portion. Then, he was treated intensively with IVH, enteral nutrition and administration of PSL (iv), 5-ASA, azathioprine and metronidazole, and PSL enema. Symptoms and laboratory data were not improved. Finally, he underwent rectal amputation, resection of the terminal ileum and release of the internal fistula accompanied by construction of a simple ileostomy. After about three years, he became able to take food and enjoy snow boarding. He is really satisfied with the present surgery.

Key words
Crohn's disease, intractable perianal fistulas, rectal amputation

Reprint requests
Yukio Mikami Department of Surgery, National Sendai Hospital 2-8-8 Miyagino, Miyagino-ku, Sendai, 983-8520 JAPAN

Accepted
October 14, 1998

To read the PDF file you will need Abobe Reader installed on your computer.