Total Proctocolectomy with Ileal Pouch Anal or Anal Canal Anastomosis for Ulcerative Colitis Patients with Anorectal Complications

Kazutaka Koganei, Akira Sugita, Hideaki Kimura¹⁾, Kyoko Yamada, Ryo Futatsuki, Fumihiko Kito and Tsuneo Fukushima²⁾

Department of Surgery, Yokohama Citizen's Municipal Hospital
Yokohama City University Medical Center Inflammatory Bowel Disease Center¹⁾
Matsushima Clinic²⁾

The incidence of anorectal complications in ulcerative colitis is reported to be relatively low. Problems may arise, however, if patients require surgery to treat ulcerative colitis. We studied 9 ulcerative colitis patients with anorectal complications, such as anal fistula (5 cases), and rectovaginal fistula (4). All had pancolitis with remission and relapse. Surgical indications were medical treatment failure in 4, dysplasia in 2, severe colonic disease in 2. Seven of the 9 were treated with stapled ileal pouch anal anastomosis of the anal canal with removal of the primary opening and 2 with ileal pouch anal anastomosis with rectal mucosal stripping. Postoperatively, 8 had no symptoms or recurrence of anorectal complications except for one rectovaginal fistula patient who had occasional small vaginal discharges. Bowel movements one year after surgery averaged 6.4 times a day. One patient had soiling and two had occasional soiling. All returned to ordinary life. Stapled ileal pouch anal anastomosis with removal of the primary opening and ileal pouch anal anastomosis are thus suitable for ulcerative colitis patients with symptomatic anorectal complications.

Key words
ulcerative colitis, anorectal complications, surgical treatment

Reprint requests
Kazutaka Koganei Department of Surgery, Yokohama Municipal Citizen's Hospital
56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555 JAPAN

Accepted
September 16, 2009

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