Ileitis after colectomy for ulcerative colitis

An ileitis developing years or months after ileostomy was recognised and described many years ago but has rarely been mentioned since. We describe nine patients with a non-specific preanastomotic ileitis that developed years after colectomy in patients operated on for ulcerative colitis or carcinoma. The disease developed after various types of reconstruction: ileorectal, ileoanal, with or without pouch. The diseased ileum showed inflammation, erosions, ulcerations, and sometimes strictures. The disease course ranged from asymptomatic to severe pain and diarrhoea. No specific cause could be shown. Granulomas, infectious agents or ischaemic changes were not found. The anastomosis was always patent. Three patients have had numerous episodes of intestinal obstruction presumably because of adhesions. Seven of nine patients were female. The response to steroids, 5-aminosalicyclic acid preparations, and methotrexate was poor, three patients responded well to azathioprine. The condition is not rare and the cause remains unknown. (Gut 1994; 35: 373-376) Departments of Gastroenterology, Pathology and Surgery, Tel Aviv Medical Center, Ichilov Hospital and Sackler Faculty of Medicine, Tel Aviv University A Hallak M Baratz M Santo Z Halpern M Rabau N Werbin T Gilat Correspondence to: Dr T Gilat, Department of Gastroenterology, Ichilov Hospital, 6 Weizman Street, 64239 Tel Aviv, Israel. Accepted for publication 7 July 1993 Various diseases of the colon are treated, when necessary, by removal ofthe organ. The resection may be complete (proctocolectomy) or incomplete. The number of potential reconstructions has increased in recent years and includes ileostomy with or without pouch,'4 and ileorectall or ileoanal anastomosis with or without pouch.S' Thecommon denominator ofall these procedures is that the terminal ileum is reanastomosed in a non-physiologic environment. Many decades ago it was recognised that the ileum in this situation may develop disease."'-" Thayer and Spiro in 19621' described this disease in the specific situation of ileostomy and coined the term 'prestomal ileitis'. This entity has very rarely been mentioned in past decades as exemplified in a recent review.'4 We have seen in the last three years nine cases of unexplained ileitis in association with colectomy for various causes and reconstructions of various types and now report our findings.