Total colectomy and J-pouch ileorectal anastomosis for obstructed tumours of the rectosigmoid junction.

摘要

BACKGROUND: Subtotal colectomy with ileosigmoid or ileorectal anastomosis is one of the standard procedures for obstructed tumours of the left colon. The lower the level of the anastomosis, the greater the number of bowel motions per day. The aim of the present study was to assess whether an ileal pouch-rectal anastomosis is associated with fewer bowel motions per day. METHODS: In four patients with obstructed carcinoma of the rectosigmoid junction and upper rectum, a total colectomy with removal of the upper rectum for adequate tumour clearance was used, followed by construction of a 10 cm ileal J-pouch that was subsequently anastomosed to the distal rectal stump. RESULTS: Postoperative recovery was uneventful in all patients. At 3 months postoperatively, anorectal manometry showed anal resting and squeeze pressures at lower normal limits and a neorectal capacity ranging from 160 to 310 mL. One year postoperatively, all patients experienced one to three normal bowel motions daily and no episodes of incontinence. CONCLUSIONS: Total colectomy with ileal J-pouch-rectal anastomosis is a reasonable operative alternative in cases with obstructed tumours of the rectosigmoid junction, which necessitate removal of the upper rectum.