Use of topical rectal therapy to preserve the rectum in surgery of ulcerative colitis

Colectomy with ileorectal anastomosis was performed in 27 patients affected by ulcerative colitis during the period 1969–1977. In 23 the presence of proctitis required topical rectal therapy to prepare the rectum for ileoproctostomy. Topical use of corticosteroids and sulfasalazine by daily retentio...

Full description

Saved in:
Bibliographic Details
Published in:World journal of surgery 1980-09, Vol.4 (5), p.609-613
Main Authors: Gallone, Luigi, Olmi, Luciano, Marchetti, Vincenzo
Format: Article
Language:English
Subjects:
Administration, Topical
Adult
Aged
Colitis, Ulcerative - surgery
Dexamethasone - administration & dosage
Drug Therapy, Combination
Female
Humans
Ileorectal Anastomosis
Ileum - surgery
Male
Methylprednisolone - administration & dosage
Middle Aged
Postoperative Care
Preoperative Care
Proctitis
Proctitis - drug therapy
Rectal Mucosa
Rectum - drug effects
Rectum - surgery
Solutions
Sulfasalazine
Sulfasalazine - administration & dosage
Ulcerative Colitis
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Colectomy with ileorectal anastomosis was performed in 27 patients affected by ulcerative colitis during the period 1969–1977. In 23 the presence of proctitis required topical rectal therapy to prepare the rectum for ileoproctostomy. Topical use of corticosteroids and sulfasalazine by daily retention enemas caused a regression of proctitis and allowed a safe ileorectal anastomosis. After the surgical procedure, protective treatment of the rectal mucosa was continued for life with minimal dosages of the same drugs by daily enemas. Dexamethasone and 6‐methylprednisolone in saline solution proved to be suitable corticosteroids for topical use and produced no undesirable long‐term side effects. In some patients the steroids were replaced by sulfasalazine per rectum in a daily maintenance dosage. This method of rectal care after colectomy and ileorectal anastomosis prevented relapses of proctitis and kept the rectal mucosa in good condition during follow‐up periods of 1 to 9 years. The safety of the topical treatment is directly related to performance of proctoscopic examinations at regular intervals. Provided these conditions are satisfied, colectomy with ileorectal anastomosis should be the standard surgical treatment of ulcerative proctocolitis. Résumé Entre 1969 et 1977, 27 malades souffrant de colite ulcéreuse ont subi une colectomie avec iléo‐rectostomie. Dans 23 cas, l'atteinte rectale a exigé une thérapeutique locale préparatoire à l'iléo‐rectostomie. L'application locale de corticostéroides et de sulfasalazine par lavements journaliers fait régresser les lésions rectales et permet de réaliser avec sécurité l'anastomose iléo‐rectale. Après l'operation, le traitement protecteur de la muqueuse rectale est poursuivi ad vitam avec des doses minimes des mêmes drogues administrées par lavements journaliers. La dexaméthasone et la 6‐méthylprednisolone en solution saline sont des corticostéroïdes qui conviennent pour l'administration locale, sans produire à long terme d'effets secondaires indésirables. Chez certains malades, les stéroïdes ont été remplacés par la sulfasalazine en administration locale journalière. Cette méthode de traitement du rectum après colectomie et anastomose iléo‐rectale prévient les récidives de proctite et garde la muqueuse rectale en bon état pendant des durées de follow‐up de 1 à 9 ans. La sécurité de ce traitement local est conditionnée par des rectoscopies faites à intervalles réguliers. Si ces conditions peuvent être remplies, la
ISSN:0364-2313
1432-2323
DOI:10.1007/BF02401644