Download PDF
Clin Colon Rectal Surg 2004; 17(1): 29-34
DOI: 10.1055/s-2004-823068
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Ulcerative Colitis: The Fate of the Retained Rectum

Adam Juviler1 , Neil Hyman1
  • 1Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont
Further Information

Publication History

Publication Date:
13 April 2004 (online)

    Permissions and Reprints

Ileal pouch-anal anastomosis has clearly diminished the role of colectomy and ileorectal anastomosis (IRA) in the management of patients with ulcerative colitis. Nonetheless, IRA probably still has an appropriate place in highly selected patients, and many others maintain an “out of circuit” rectal remnant after subtotal colectomy. Although symptomatic proctitis is the most common reason for completion proctectomy, these patients are also at a significant risk to develop rectal cancer. Routine surveillance appears to be warranted.

KEYWORDS

Ulcerative colitis - proctitis - ileorectal anastomosis

REFERENCES

  • 1 Leijonmarck C-E, Lofberg R, Ost A, Hellers G. Long-term results of ileorectal anastomosis in ulcerative colitis in Stockholm County.  Dis Colon Rectum. 1990;  33 195-200
    CrossrefPubMedGoogle Scholar
  • 2 Pastore R LO, Wolff B G, Hodge D. Total abdominal colectomy and ileorectal anastomosis for inflammatory bowel disease.  Dis Colon Rectum. 1997;  40 1455-1464
    CrossrefPubMedGoogle Scholar
  • 3 Soravia C, O'Connor B I, Berk T, McLeod R S, Cohen Z. Functional outcome of conversion of ileorectal anastomosis to ileal pouch-anal anastomosis in patients with familial adenomatous polyposis and ulcerative colitis.  Dis Colon Rectum. 1999;  42 903-908
    PubMedGoogle Scholar
  • 4 Melville D M, Ritchie J K, Nicholls R J, Hawley P R. Surgery for ulcerative colitis in the era of the pouch: the St. Mark's Hospital experience.  Gut. 1994;  35 1076-1080
    PubMedGoogle Scholar
  • 5 Watts J M, Hughes S R. Ulcerative colitis and Crohn's disease: results after colectomy and ileorectal anastomosis.  Br J Surg. 1977;  64 77-83
    PubMedGoogle Scholar
  • 6 Johnson W R, McDermott F T, Hughes E SR, Pihl E A, Milne B J, Price A B. The risk of rectal carcinoma following colectomy in ulcerative colitis.  Dis Colon Rectum. 1983;  26 44-46
    CrossrefPubMedGoogle Scholar
  • 7 Oakley J R, Lavery I C, Fazio V W, Jagelman D G, Weakley F L, Easley K. The fate of the rectal stump after subtotal colectomy for ulcerative colitis.  Dis Colon Rectum. 1985;  28 394-396
    CrossrefPubMedGoogle Scholar
  • 8 Hyman N H, Fazio V W, Tuckson W B, Lavery I C. Consequences of ileal pouch-anal anastomosis for Crohn's colitis.  Dis Colon Rectum. 1991;  34 653-657
    PubMedGoogle Scholar
  • 9 Becker J M. Surgical therapy for ulcerative colitis and Crohn's disease.  Gastroenterol Clin North Am. 1999;  28 371-390
    CrossrefPubMedGoogle Scholar
  • 10 Hawley P R. Ileorectal anastomosis.  Br J Surg. 1985;  72 S75-S82
    PubMedGoogle Scholar
  • 11 Hyman N. Rectal cancer as a complication of stapled IPAA.  Inflamm Bowel Dis. 2002;  8 43-45
    CrossrefPubMedGoogle Scholar
  • 12 Leijonmarck C-E, Brostrom O, Monsen U, Hellers G. Surgical treatment of ulcerative colitis in Stockholm County, 1955 to 1984.  Dis Colon Rectum. 1989;  32 918-926
    PubMedGoogle Scholar
  • 13 Baker W NW. The results of ileorectal anastomosis at St. Mark's Hospital from 1953 to 1968.  Gut. 1970;  11 235-239
    PubMedGoogle Scholar
  • 14 Aylett S O. Three hundred cases of diffuse ulcerative colitis treated by total colectomy and ileorectal anastomosis.  BMJ. 1966;  5494 1001-1005
    PubMedGoogle Scholar
  • 15 Khubchandani I T, Trimpi H D, Sheets J A, Stasik J J, Klecknr F S. Ileorectal anastomosis for ulcerative colitis and Crohn's colitis.  Am J Surg. 1978;  135 751-756
    CrossrefPubMedGoogle Scholar
  • 16 Johnson W R, Hughes E SR, McDermott F T, Pihl E A, Katrivessis H. The outcome of patients with ulcerative colitis managed by subtotal colectomy.  Surg Gynecol Obstet. 1986;  162 421-425
    PubMedGoogle Scholar
  • 17 Khubchandani I T, Sanfort M R, Rosen L, Sheets J A, Stasik J J, Riether R D. Current status of ileorectal anastomosis for inflammatory bowel disease.  Dis Colon Rectum. 1989;  32 400-403
    PubMedGoogle Scholar
  • 18 Goudet P, Dozois R R, Kelly K A, Melton J, Ilstrup D M, Phillips S F. Changing referral patterns for surgical treatment of ulcerative colitis.  Mayo Clin Proc. 1996;  71 743-747
    PubMedGoogle Scholar
  • 19 Berg D F, Bahadursingh A M, Kaminski D L, Longo W E. Acute surgical emergencies in inflammatory bowel disease.  Am J Surg. 2002;  184 45-51
    CrossrefPubMedGoogle Scholar
  • 20 Baker W NW, Glass R E, Ritchie J K, Aylett S O. Cancer of the rectum following colectomy and ileorectal anastomosis for ulcerative colitis.  Br J Surg. 1978;  65 862-868
    PubMedGoogle Scholar
  • 21 Carter F M, McLeod R S, Cohen Z. Subtotal colectomy for ulcerative colitis: complications related to the rectal remnant.  Dis Colon Rectum. 1991;  34 1005-1009
    CrossrefPubMedGoogle Scholar
  • 22 Marcello P W, Milsom J W, Wong S K, Brady K, Goormastic M, Fazio V W. Laparoscopic total colectomy for acute colitis: a case control study.  Dis Colon Rectum. 2001;  44 1441-1445
    CrossrefPubMedGoogle Scholar
  • 23 Gyde S N, Prior P, Allan R N et al.. Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centers.  Gut. 1988;  29 206-217
    CrossrefPubMedGoogle Scholar
  • 24 Wandall E P, Damkier P, Pedersen F M, Wilson B, de Muckadell O BS. Survival and incidence of colorectal cancer in patients with ulcerative colitis in Funen County diagnosed between 1973 and 1993.  Scand J Gastroenterol. 2000;  35 312-317
    CrossrefPubMedGoogle Scholar
  • 25 Binder S C, Miller H H, Deterling R A. Fate of the retained rectum after subtotal colectomy for inflammatory disease of the colon.  Am J Surg. 1976;  131 201-203
    CrossrefPubMedGoogle Scholar
  • 26 Jones P F, Bevan P G, Hawley P R. Ileostomy or ileorectal anastomosis for ulcrative colitis?.  BMJ. 1978;  1 1459-1463
    PubMedGoogle Scholar
  • 27 Khubchandani I T, Stasik J J, Nedwick A. Prospective surveillance by rectal biopsy following ileorectal anastomosis for inflammatory disease.  Dis Colon Rectum. 1982;  25 343-347
    PubMedGoogle Scholar
  • 28 Lofberg R, Leijonmarck C-E, Brostrom O, Hellers G, Tribukait B, Ost A. Mucosal dysplasia and DNA content in ulcerative colitis patients with ileorectal anastomosis: follow-up study in defined patient group.  Dis Colon Rectum. 1991;  34 566-571
    PubMedGoogle Scholar
  • 29 Fazio V W. Toxic megacolon in ulcerative colitis and Crohn's colitis.  Clin Gastroenterol. 1980;  9 389-407
    PubMedGoogle Scholar
  • 30 Karlen P, Kornfeld D, Brostrom O, Lofberg R, Persson P-G, Ekbom A. Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis?: a population based case control study.  Gut. 1998;  42 711-714
    PubMedGoogle Scholar
  • 31 Hyman N. Treating the malignant complications of inflammatory bowel disease.  Semin Colon Rectal Surg. 2001;  12 55-59
    PubMedGoogle Scholar
  • 32 Lennard-Jones J E, Melville D M, Morson B C, Ritchie J K, Williams C B. Precancer and cancer in extensive ulcerative colitis: findings among 401 patients over 22 years.  Gut. 1990;  31 800-806
    CrossrefPubMedGoogle Scholar
  • 33 Ekbom A, Helmick C, Zack M, Adami H-O. Ulcerative colitis and colorectal cancer: a population-based study.  N Engl J Med. 1990;  323 1228-1233
    CrossrefPubMedGoogle Scholar
  • 34 Levin B. Inflammatory bowel disease and colon cancer.  Cancer. 1992;  70 1313-1316
    PubMedGoogle Scholar
  • 35 Langholz E, Munkholm P, Davidsen M, Binder V. Colorectal cancer risk and mortality in patients with ulcerative colitis.  Gastroenterology. 1992;  103 1444-1451
    PubMedGoogle Scholar
  • 36 Mir-Madjlessi S H, Farmer R G, Easley K A, Beck G J. Colorectal and extracolonic malignancy in ulcerative colitis.  Cancer. 1986;  58 1569-1574
    CrossrefPubMedGoogle Scholar
  • 37 Lennard-Jones J E. Cancer risk in ulcerative colitis: surveillance or surgery.  Br J Surg. 1985;  72 S84-S86
    PubMedGoogle Scholar
  • 38 Connell W R, Lennard-Jones J E, Williams C B, Talbot I C, Price A B, Wilkinson K H. Factors affecting the outcome of endoscopic surveillance for cancer in ulcerative colitis.  Gastroenterology. 1994;  107 934-944
    CrossrefPubMedGoogle Scholar
  • 39 Kornbluth A, Sachar D B. Ulcerative colitis practice guidelines in adults.  Am J Gastroenterol. 1997;  92 204-211
    PubMedGoogle Scholar
  • 40 Collins R H, Feldman M, Fordtran J S. Colon cancer dysplasia, and surveillance in patients with ulcerative colitis: a critical review.  N Engl J Med. 1987;  316 1654-1658
    CrossrefPubMedGoogle Scholar
  • 41 Gillen C D, Walmsley R S, Prior P, Andrews H A, Allan R N. Ulcerative colitis and Crohn's disease: a comparison of the colorectal cancer risk in extensive colitis.  Gut. 1994;  35 1590-1592
    CrossrefPubMedGoogle Scholar
  • 42 Lennard-Jones J E, Morson B C, Ritchie J K, Shove D C, Williams C B. Cancer in colitis: assessment of the individual risk by clinical and histological criteria.  Gastroenterology. 1977;  73 1280-1289
    PubMedGoogle Scholar
  • 43 Grundfest S F, Fazio V, Weiss R A et al.. The risk of cancer following colectomy and ileorectal anastomosis for extensive mucosal ulcerative colitis.  Ann Surg. 1981;  193 9-14
    CrossrefPubMedGoogle Scholar
  • 44 Backer O, Hjortrup A, Kjaergaard J. Evaluation of ileorectal anastomosis for the treatment of ulcerative colitis.  J R Soc Med. 1988;  81 210-211
    PubMedGoogle Scholar
  • 45 Oakley J R, Jagelman D G, Fazio V W et al.. Complications and quality of life after ileorectal anastomosis for ulcerative colitis.  Am J Surg. 1985;  149 23-30
    PubMedGoogle Scholar
  • 46 Coull D B, Lee F D, Henderson A P, Anderson J H, McKee R F, Finlay I G. Risk of dysplasia in the columnar cuff after stapled restorative proctocolectomy.  Br J Surg. 2003;  90 72-75
    CrossrefPubMedGoogle Scholar
  • 47 Stern H, Walfisch S, Mullen B, McLeod R, Cohen Z. Cancer in an ileoanal reservoir: a new late complication?.  Gut. 1990;  31 473-475
    CrossrefPubMedGoogle Scholar
  • 48 Puthu D, Rajan N, Rao R, Rao L, Venugopal P. Carcinoma of the rectal pouch following restorative proctocolectomy: report of a case.  Dis Colon Rectum. 1992;  35 257-260
    PubMedGoogle Scholar
  • 49 Ziv Y, Fazio V W, Sirimarco M T, Lavery I C, Goldblum J R, Petras R E. Incidence, risk factors, and treatment of dysplasia in the anal transition zone after ileal pouch-anal anastomosis.  Dis Colon Rectum. 1994;  37 1281-1285
    CrossrefPubMedGoogle Scholar
  • 50 Choi P M, Nugent F W, Schoetz Jr D J, Silverman M L, Haggitt R C. Colonoscopic surveillance reduces mortality from colorectal cancer in ulcerative colitis.  Gastroenterology. 1993;  105 418-424
    PubMedGoogle Scholar
  • 51 Axon A TR. Cancer surveillance in ulcerative colitis-a time for reappraisal.  Gut. 1994;  35 587-589
    PubMedGoogle Scholar
  • 52 Bernstein C N, Shanahan F, Winstein W M. Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis?.  Lancet. 1994;  343 71-74
    CrossrefPubMedGoogle Scholar
  • 53 Greenstein A J. Cancer in inflammatory bowel disease.  Mt Sinai J Med. 2000;  67 227-240
    PubMedGoogle Scholar
  • 54 Johnson W R, McDermott F T, Pihl E, Hughes E SR. Mucosal dysplasia: a major predictor of cancer following ileorectal anastomosis.  Dis Colon Rectum. 1983;  26 697-700
    CrossrefPubMedGoogle Scholar
  • 55 Farnell M B, Van Heerden J A, Beart R W, Weiland L H. Rectal preservation in nonspecific inflammatory disease of the colon.  Ann Surg. 1980;  192 249-253
    PubMedGoogle Scholar
  • 56 Elton C, Makin G, Hitos K, Cohen C RG. Mortality, morbidity and functional outcome after ileorectal anastomosis.  Br J Surg. 2003;  90 59-65
    CrossrefPubMedGoogle Scholar

Neil HymanM.D. 

Fletcher 301, MCHV Campus, Department of Surgery, University of Vermont, College of Medicine, Burlington, VT 05401

Email: Neil.Hyman@vtmednet.org

      >