Surgery of aggressive idiopathic proctocolitis and principles of rectal preservation

During 1969-1985 seventy-one patients with aggressive idiopathic disease of the large intestine (i.e. ulcerative and Crohn's proctocolitis) were treated by colectomy and ileorectal anastomosis (IRA). In sixty-two of them proctitis was associated with colitis and required topical preparation of the rectum. The use of an antiphlogistic drug (6-methylprednisolone or betamethasone) in saline solution by daily enemas was followed by proctitis regression and permitted a safe IRA. After the surgical procedure the rectal treatment with the same drugs in smaller doses continued, so as to prevent long-term side effects. In some patients the steroid was replaced periodically by sulphasalazine per os or by 5-ASA per rectum in a daily maintenance dosage. This rectal care for unlimitated time has proved able to prevent recurrences of proctitis, while the epithelial recovery with regression of dysplasia gives protection against the risk of cancer.