Subtotal colectomy with Hartmann's pouch for inflammatory bowel disease
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 intraperitoneal Hartmann's...
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Veröffentlicht in: | Diseases of the colon & rectum 1995-06, Vol.38 (6), p.635-639 |
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creator | KARCH, L. A BAUER, J. J GORFINE, S. R GELERNT, I. M |
description | 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 intraperitoneal Hartmann's closure to determine whether this is an acceptable way to handle the rectal remnant.
We retrospectively reviewed hospital and office records of 114 consecutive patients with IBD colitis who underwent STC with Hartmann's pouch since 1988. Patient demographic data, operative details, and postoperative complications were recorded. In patients who underwent subsequent surgery, technical difficulty and complications related to rectal dissection were documented.
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 patient responded dramatically to antibiotics and transanal catheter decompression of the Hartmann's pouch. Subsequent to this experience, patients undergoing STC and Hartmann's closure for IBD colitis had transanal catheter drainage of the rectal remnant as a routine part of their postoperative care. There were no instances of leakage among the 41 patients who underwent rectal decompression. There were two reports (3 percent) of technical difficulty in locating or mobilizing the intraperitoneal rectal remnant at 60 subsequent surgical procedures.
Intraperitoneal Hartmann's closure of the rectum is the preferred management in patients with intractable IBD colitis requiring STC. |
doi_str_mv | 10.1007/BF02054125 |
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We retrospectively reviewed hospital and office records of 114 consecutive patients with IBD colitis who underwent STC with Hartmann's pouch since 1988. Patient demographic data, operative details, and postoperative complications were recorded. In patients who underwent subsequent surgery, technical difficulty and complications related to rectal dissection were documented.
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 patient responded dramatically to antibiotics and transanal catheter decompression of the Hartmann's pouch. Subsequent to this experience, patients undergoing STC and Hartmann's closure for IBD colitis had transanal catheter drainage of the rectal remnant as a routine part of their postoperative care. There were no instances of leakage among the 41 patients who underwent rectal decompression. There were two reports (3 percent) of technical difficulty in locating or mobilizing the intraperitoneal rectal remnant at 60 subsequent surgical procedures.
Intraperitoneal Hartmann's closure of the rectum is the preferred management in patients with intractable IBD colitis requiring STC.</description><identifier>ISSN: 0012-3706</identifier><identifier>EISSN: 1530-0358</identifier><identifier>DOI: 10.1007/BF02054125</identifier><identifier>PMID: 7774477</identifier><identifier>CODEN: DICRAG</identifier><language>eng</language><publisher>Secaucus, NJ: Springer</publisher><subject>Adolescent ; Adult ; Aged ; Biological and medical sciences ; Colectomy - methods ; Female ; Humans ; Ileostomy ; Inflammatory Bowel Diseases - surgery ; Male ; Medical sciences ; Middle Aged ; Postoperative Complications ; Rectum - surgery ; Reoperation ; Retrospective Studies ; Stomach, duodenum, intestine, rectum, anus ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system</subject><ispartof>Diseases of the colon & rectum, 1995-06, Vol.38 (6), p.635-639</ispartof><rights>1995 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c311t-e5a46cb029fec4c85b06b7f5abbaa6e1b4e50c40e239476158c4226d32e977303</citedby><cites>FETCH-LOGICAL-c311t-e5a46cb029fec4c85b06b7f5abbaa6e1b4e50c40e239476158c4226d32e977303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,780,784,789,790,23930,23931,25140,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3579083$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7774477$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>KARCH, L. A</creatorcontrib><creatorcontrib>BAUER, J. J</creatorcontrib><creatorcontrib>GORFINE, S. R</creatorcontrib><creatorcontrib>GELERNT, I. M</creatorcontrib><title>Subtotal colectomy with Hartmann's pouch for inflammatory bowel disease</title><title>Diseases of the colon & rectum</title><addtitle>Dis Colon Rectum</addtitle><description>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 intraperitoneal Hartmann's closure to determine whether this is an acceptable way to handle the rectal remnant.
We retrospectively reviewed hospital and office records of 114 consecutive patients with IBD colitis who underwent STC with Hartmann's pouch since 1988. Patient demographic data, operative details, and postoperative complications were recorded. In patients who underwent subsequent surgery, technical difficulty and complications related to rectal dissection were documented.
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 patient responded dramatically to antibiotics and transanal catheter decompression of the Hartmann's pouch. Subsequent to this experience, patients undergoing STC and Hartmann's closure for IBD colitis had transanal catheter drainage of the rectal remnant as a routine part of their postoperative care. There were no instances of leakage among the 41 patients who underwent rectal decompression. There were two reports (3 percent) of technical difficulty in locating or mobilizing the intraperitoneal rectal remnant at 60 subsequent surgical procedures.
Intraperitoneal Hartmann's closure of the rectum is the preferred management in patients with intractable IBD colitis requiring STC.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Colectomy - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Ileostomy</subject><subject>Inflammatory Bowel Diseases - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications</subject><subject>Rectum - surgery</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><issn>0012-3706</issn><issn>1530-0358</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpF0M1LwzAYBvAgypzTi3chB1EQqm--mu6oQzdh4EE9lyRLWSVtZpIy9t_bsTJPLy_Pj-fwIHRN4JEAyKeXN6AgOKHiBI2JYJABE8UpGgMQmjEJ-Tm6iPGnf3soR2gkpeRcyjGaf3Y6-aQcNt5Zk3yzw9s6rfFChdSotr2PeOM7s8aVD7huK6eaRiUfdlj7rXV4VUeror1EZ5Vy0V4Nd4K-316_Zots-TF_nz0vM8MISZkViudGA51W1nBTCA25lpVQWiuVW6K5FWA4WMqmXOZEFIZTmq8YtVMpGbAJujv0boL_7WxMZVNHY51TrfVdLPdI5pz18OEATfAxBluVm1A3KuxKAuV-tfJ_tR7fDK2dbuzqSIeZ-vx2yFU0ylVBtaaOR8aEnELB2B82TXNS</recordid><startdate>19950601</startdate><enddate>19950601</enddate><creator>KARCH, L. A</creator><creator>BAUER, J. J</creator><creator>GORFINE, S. R</creator><creator>GELERNT, I. M</creator><general>Springer</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19950601</creationdate><title>Subtotal colectomy with Hartmann's pouch for inflammatory bowel disease</title><author>KARCH, L. A ; BAUER, J. J ; GORFINE, S. R ; GELERNT, I. M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c311t-e5a46cb029fec4c85b06b7f5abbaa6e1b4e50c40e239476158c4226d32e977303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Colectomy - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Ileostomy</topic><topic>Inflammatory Bowel Diseases - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Complications</topic><topic>Rectum - surgery</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>KARCH, L. A</creatorcontrib><creatorcontrib>BAUER, J. J</creatorcontrib><creatorcontrib>GORFINE, S. R</creatorcontrib><creatorcontrib>GELERNT, I. M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Diseases of the colon & rectum</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>KARCH, L. A</au><au>BAUER, J. J</au><au>GORFINE, S. R</au><au>GELERNT, I. M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Subtotal colectomy with Hartmann's pouch for inflammatory bowel disease</atitle><jtitle>Diseases of the colon & rectum</jtitle><addtitle>Dis Colon Rectum</addtitle><date>1995-06-01</date><risdate>1995</risdate><volume>38</volume><issue>6</issue><spage>635</spage><epage>639</epage><pages>635-639</pages><issn>0012-3706</issn><eissn>1530-0358</eissn><coden>DICRAG</coden><abstract>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 intraperitoneal Hartmann's closure to determine whether this is an acceptable way to handle the rectal remnant.
We retrospectively reviewed hospital and office records of 114 consecutive patients with IBD colitis who underwent STC with Hartmann's pouch since 1988. Patient demographic data, operative details, and postoperative complications were recorded. In patients who underwent subsequent surgery, technical difficulty and complications related to rectal dissection were documented.
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 patient responded dramatically to antibiotics and transanal catheter decompression of the Hartmann's pouch. Subsequent to this experience, patients undergoing STC and Hartmann's closure for IBD colitis had transanal catheter drainage of the rectal remnant as a routine part of their postoperative care. There were no instances of leakage among the 41 patients who underwent rectal decompression. There were two reports (3 percent) of technical difficulty in locating or mobilizing the intraperitoneal rectal remnant at 60 subsequent surgical procedures.
Intraperitoneal Hartmann's closure of the rectum is the preferred management in patients with intractable IBD colitis requiring STC.</abstract><cop>Secaucus, NJ</cop><pub>Springer</pub><pmid>7774477</pmid><doi>10.1007/BF02054125</doi><tpages>5</tpages></addata></record> |
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subjects | Adolescent Adult Aged Biological and medical sciences Colectomy - methods Female Humans Ileostomy Inflammatory Bowel Diseases - surgery Male Medical sciences Middle Aged Postoperative Complications Rectum - surgery Reoperation Retrospective Studies Stomach, duodenum, intestine, rectum, anus Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system |
title | Subtotal colectomy with Hartmann's pouch for inflammatory bowel disease |
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