Clinical, endoscopic and histologic review in patients submitted to colectomy and ileorectal anastomosis for ulcerative colitis.
The main advantage of colectomy and ileorectal anastomosis performed in patients with ulcerative colitis is the preservation of the rectum and anal continence. However, it represents a high-risk condition for the development of carcinoma in the rectal stump. Thirty-five patients submitted to colectomy and ileorectal anastomosis for ulcerative colitis were interviewed and reviewed through endoscopic and histologic examinations of the rectum. Timing of the investigations varied according to the duration of the disease. Twenty-four patients who had the disease for less than 10 years (Group I) were examined every 12 months, whereas 11 patients (Group II) who had the disease for over 10 years were reviewed every 6 months. Endoscopic aspects of inflammation were graded as mild, moderate or severe. At histology, the disease was classified as quiescent, active or healed. Follow-up was 1-5.6 years. At one year, one patient of Group II presented persistent severe dysplasia on specimens taken from a flat area of rectal mucosa. Proctectomy was advised and performed. Anal complications arose in two patients: anal fissure (1) and anal fissure associated with an anal fistula (1). Endoscopic and histologic improvement of the rectal mucosa was observed in 45% and 54% of the patients in Group I and II respectively. At 5 years, endoscopic, histologic and clinical improvement was noted in 76%, 61% and 85% of the patients respectively. Colectomy and ileorectal anastomosis can be considered a valid procedure in a selected group of patients with ulcerative colitis, provided that regular endoscopic, histologic and clinical review is carried out to permit early detection of premalignant changes in the rectal stump.