SUBTOTAL COLECTOMY WITH HARTMANNS POUCH FOR INFLAMMATORY BOWEL-DISEASE

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.