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Subcutaneous rectal stump closure after emergency subtotal colectomy.
R L Ng1, A H Davies, R H Grace
1Department of Surgery, John Radcliffe Hospital, Oxford, UK.
The British Journal of Surgery
|July 1, 1992
Summary
Subtotal colectomy with rectal stump closure is a safe emergency surgery for severe colitis. This technique, placing the rectal stump subcutaneously, offers a simple alternative to open mucus fistulas with a low complication rate.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Severe colitis often necessitates emergency surgery, with subtotal colectomy preserving the rectum being the preferred approach.
- Managing the retained rectal stump is crucial in these procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of subcutaneous rectal stump closure during emergency subtotal colectomy for severe colitis.
Main Methods:
- Thirty-two patients with severe inflammatory bowel disease underwent emergency colectomy with subcutaneous rectal stump closure.
- Closure methods included staples, sutures, or a combination.
- An anal catheter was used for rectal drainage in some cases.
Main Results:
- Complications occurred in 22% of patients (7/32), with two requiring further surgical intervention.
- One significant wound infection was successfully treated with antibiotics; three minor infections did not require intervention.
- The rectal stump was consistently easy to locate for subsequent restorative surgery.
Conclusions:
- Subcutaneous rectal stump closure is a simple, safe, and effective alternative to open mucus fistulas for emergency subtotal colectomy.
- Adherence to surgical principles, particularly avoiding tension on the distal bowel, is essential for successful outcomes.