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

Abstract

Objective: Subtotal colectomy (STC) with end ileostomy is recommended for acute severe colitis. Controversy exists surrounding the optimal management of the rectal stump. This study reviews the clinical outcomes in patients who have had a STC for acute colitis. Methods: Analysis of prospective data of patients who had STC for severe acute colitis over a 10 year period in a tertiary referral centre. Results: 66 patients had STC from 2010 until 2019, with average age 40.5 years. 54% were female and 46% male. STC was performed for fulminant colitis in 40%, failure of medical therapy in 56%, and for colonic strictures in 4%. Complications included peritonitis in 9%; wound infection in 6%, ileus in 15%, conversion to open in 2%, and stoma problems in 6%. The rectal stump was closed at the level of the recto-sigmoid junction in 98% and in 2% a mucous fistula was created. 73% of patients had no further surgery, but 27% underwent completion proctectomy. Patients were followed up for 6.25 years. 17% of patients who had a completion proctectomy underwent IPAA. Conclusion: STC with closed rectal stump and end ileostomy is the recommended procedure in severe acute colitis refractory to medical therapy or in fulminant colitis. Given the morbidity associated with a mucous fistula, we believe that this procedure should be abandoned. Pelvic dissection should not be performed at the time of the emergency STC given the risk of morbidity and to reduce difficulty for future pelvic dissection should a proctectomy or IPAA be performed.