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

Abstract

Abstract 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.