Severe ulcerative colitis disrupts daily routines, decreases quality of life, and may result in steroid dependence. Severe UC may lead to the potentially life-threatening conditions toxic megacolon and cancer.Toxic megacolon and colon rupture require emergency surgery. Colectomy may be offered as an elective surgery to patients whose quality of life is greatly affected by their symptoms, or who are at high risk for development of colorectal cancer.
Colon surgery effectively cures ulcerative colitis. With appropriate education on postoperative care, this treatment has a good long-term outcome and drastically improves quality of life.
Proctocolectomy with Ileostomy
The most common colon surgery is the proctocolectomy: the removal of the colon and rectum. A second procedure performed along with the proctocolectomy is an ileostomy, which can be done in one of two ways.
In the Brooke ileostomy the end of the small intestine (the ileum) is rerouted to an opening (stoma) in the abdomen through which fecal matter is expelled. Fecal matter is collected in a pouch worn at the beltline over the stoma and emptied as necessary.
In the continent ileostomy, the surgeon creates an internal pouch out of the ileum to collect fecal matter. This pouch is emptied periodically by inserting a tube through a “valve” in the patient’s side. An external pouch is only worn for a short time following the surgery.
The Pull-Through Procedure
In the pull-through procedure (ileoanal anastomosis) the diseased colon and the lining of the rectum (mucosa) are removed. The ileum is then attached to the inside of the rectum and the anus. This creates a pouch where the fecal matter is collected. Because the rectal muscles are not touched, this procedure allows the patient to have normal bowel movements through the anus.
|Definition: Anastomosis. The connection of two structures that are normally unattached is called an anastomosis. In the pull-through procedure an anastomosis is created between the small intestine and the anus.|
Side Effects of Colectomy
The colon is the location in the gastrointestinal tract where water from the feces is absorbed. After proctocolectomy, because it has not had a chance to run through the colon, the fecal matter that is expelled through the stoma or collected in the internal pouch is quite watery. Those who have had the pull-through procedure may find their bowel movements are also more frequent—possibly as many as eight a day.
Malfunctioning of the valve used in the continent ileostomy requires corrective surgery. “Pouchitis”—inflammation of the pouch—can occur with the continent ileostomy and pull-through procedures. Pouchitis is treated with antibiotics.