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 int
raperitoneal Hartmann's closure to determine whether this is an accept
able way to handle the rectal remnant. METHODS: We retrospectively rev
iewed hospital and office records of 114 consecutive patients with IBD
colitis who underwent STC with Hartmann's pouch since 1988. Patient d
emographic data, operative details, and postoperative complications we
re recorded. In patients who underwent subsequent surgery, technical d
ifficulty and complications related to rectal dissection were document
ed. 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 patien
t responded dramatically to antibiotics and transanal catheter decompr
ession of the Hartmann's pouch. Subsequent to this experience, patient
s undergoing STC and Hartmann's closure for IBD colitis had transanal
catheter drainage of the rectal remnant as a routine part of their pos
toperative care. There were no instances of leakage among the 41 patie
nts who underwent rectal decompression. There were two reports (3 perc
ent) of technical difficulty in locating or mobilizing the intraperito
neal rectal remnant at GO subsequent surgical procedures. CONCLUSION:
Intraperitoneal Hartmann's closure of the rectum is the preferred mana
gement in patients with intractable IBD colitis requiring STC.