Fate of the rectum and distal colon after subtotal colectomy for ulcerative colitis.

Once the gastroenterologist and surgeon have agreed that there is an indication for definitive surgery in the patient with ulcerative colitis, they usually intend that the entire colon and rectum be resected. The operation of choice, then, should be a total proctocolectomy with ileostomy. In practice, however, a lesser initial procedure has been favoured in most cases, so that the subtotal colectomy with ileostomy has been the most frequently performed operation for ulcerative colitis in the past two decades. In some cases the distal segment would be resected electively soon afterwards, but in other cases the clinical course following the initial operation served to alter the original plan. The purpose of the present study was to determine the clinical behaviour and the later management of this residual segment, and to consider how its fate should influence the choice of surgical procedures for ulcerative colitis. The hospital records were further reviewed to gather information about the later status of the distal segment and whether and when an abdominoperineal resection was performed and if so the apparent indication. In most cases the private records of the attending gastroenterologist or surgeon or both were reviewed in order to acquire the necessary data. In other cases it was necessary to trace the patient or his family and hence to contact physicians or surgeons or hospital record rooms locally or at great distances to determine the late follow-up.