Subcutaneous rectal stump closure after emergency subtotal colectomy

Abstract

Subtotal colectomy with preservation of the rectum is now the procedure of choice for patients with severe colitis requiring emergency surgery. The use of subcutaneous 'rectal closure' when the retained distal bowel is placed at the caudal end of the abdominal incision in the subcutaneous or fascial layer is studied. An anal catheter may be placed to drain the rectum. Thirty-two patients (14 men, 18 women) of mean age 33 (range 17-77) years with severe inflammatory bowel disease (29 ulcerative colitis, one Crohn's disease, one indeterminate colitis, one Campylobacter colitis) underwent emergency colectomy with subcutaneous rectal stump closure. Twenty-three stumps were closed with staples, four sutured and five by both staples and sutures. Complications developed in seven patients (22 per cent), of which two required surgical intervention. One significant wound infection was treated successfully with a course of antibiotics. Three minor wound infections did not require specific treatment. The rectal stump was always readily located at the time of restorative surgery. This technique is recommended as a simple and safe alternative to an open mucus fistula provided that surgeons adhere to standard surgical principles; in particular the distal bowel should not be brought out into the wound under tension.