Abstract
PURPOSE: Fulminant or unremitting colitis caused by inflammatory bowel disease (IBD) is effectively managed by subtotal colectomy (STC) and standard ileostomy. However, controversy exists regarding the optimal management of the retained rectum. We reviewed our experience with intraperitoneal Hartmann's closure to determine whether this is an acceptable way to handle the rectal remnant. METHODS: We retrospectively reviewed hospital and office records of 114 consecutive patients with IBD colitis who underwent STC with Hartmann's pouch since 1988. Patient demographic data, operative details, and postoperative complications were recorded. In patients who underwent subsequent surgery, technical difficulty and complications related to rectal dissection were documented. RESULTS: There were three instances of pelvic sepsis secondary to leakage from the Hartmann's pouch, an overall incidence of 2.6 percent. Two of these patients required exploratory surgery. The third patient responded dramatically to antibiotics and transanal catheter decompression of the Hartmann's pouch. Subsequent to this experience, patients undergoing STC and Hartmann's closure for IBD colitis had transanal catheter drainage of the rectal remnant as a routine part of their postoperative care. There were no instances of leakage among the 41 patients who underwent rectal decompression. There were two reports (3 percent) of technical difficulty in locating or mobilizing the intraperitoneal rectal remnant at 60 subsequent surgical procedures. CONCLUSION: Intraperitoneal Hartmann's closure of the rectum is the preferred management in patients with intractable IBD colitis requiring STC.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Block GE, Moossa AR, Simonowitz D, Hassan S. Emergency colectomy for inflammatory bowel disease. Surg 1977;82:531–6.
Carter FM, McLeod RS, Cohen Z. Subtotal colectomy for ulcerative colitis: complications related to the rectal remnant. Dis Colon Rectum 1991;34:1005–9.
Harling H, Hegnhoj J, Rasmussen TN, Jarnum S. Fate of the rectum after colectomy and ileostomy for Crohn's colitis. Dis Colon Rectum 1991;34:931–5.
Kyle SM, Steyn RS, Keenan RA. Management of the rectum following colectomy for acute colitis. Aust N Z J Surg 1992;62:196–9.
Lee EC, Truelove SC. Proctocolectomy for ulcerative colitis. World J Surg 1980;4:195–201.
Morgan B, Glenn D, Vickers C. Colectomy and ileostomy in the management of ulcerative colitis. Can J Surg 1987;30:354–5.
Hawley PR. Emergency surgery for ulcerative colitis. World J Surg 1988;12:169–173.
Binder SC, Miller HH, Deterling RA. Emergency and urgent operations for ulcerative colitis. Arch Surg 1975;110:284–9.
Motson RW, Manche AR. Modified Hartmann procedure for acute ulcerative colitis. Surg Gynecol Obstet 1985;160:462–3.
McLeod RS. Emergency colectomy in colitis. Int J Colorectal Dis 1989;4:200–3.
Moss GS, Keddie N. Fate of rectal stump in ulcerative colitis. Arch Surg 1965;91:967–70.
Author information
Authors and Affiliations
Additional information
Read at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, May 2 to 7, 1993.
About this article
Cite this article
Karch, L.A., Bauer, J.J., Gorfine, S.R. et al. Subtotal colectomy with Hartmann's pouch for inflammatory bowel disease. Dis Colon Rectum 38, 635–639 (1995). https://doi.org/10.1007/BF02054125
Issue Date:
DOI: https://doi.org/10.1007/BF02054125