SAFETY OF URGENT RESTORATIVE PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS FOR FULMINANT COLITIS

PURPOSE: Subtotal colectomy with ileostomy is the operation of choice for patients with fulminant colitis. Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is preferred for patients wh o undergo elective surgery for ulcerative colitis. We retrospectively evaluated the safety of RPC with IPAA in patients with a moderate form of fulminant colitis. METHODS: A chart review of 737 patients who und erwent RPC with IPAA for ulcerative and indeterminate colitis from 198 3 through 1992 was performed. Moderate fulminant colitis was defined a s acute disease requiring hospitalization and parenteral steroid thera py, but without hypotension (systolic blood pressure, <100 mmHg), tach ycardia (>120 beats/min), or megacolon. RESULTS: Twelve patients with moderate fulminant colitis underwent urgent surgery (1.6 percent). The y had been treated preoperatively for 5.1 +/- 2.3 days with intravenou s high-dose steroids, total parenteral nutrition, and antibiotics. The se patients had a shorter length of disease (P = 0.01), lower hemoglob in, hematocrit, and albumin. (P = 0.001), and higher temperature (P = 0.002) and leukocyte count (P = 0.007) than patients undergoing electi ve surgery. No early septic complications occurred, although perianal abscess occurred in one patient and pouch-anal fistula in another pati ent, 13 and 14 months after surgery, respectively. CONCLUSION: In care fully selected, hemodynamically stable patients with fulminant colitis and without megacolon, RPC with IPAA can be safely performed.