Closed cutaneous left iliac fossa mucus fistula after emergency subtotal colectomy.

摘要

Patients with ulcerative colitis often require an emergency subtotal colectomy with end ileostomy. Such individuals may be septic and heavily immunosuppressed making management of the rectal stump problematic. If closed and left within the peritoneal cavity it can break down, resulting in pelvic sepsis. A safer alternative is to leave this as an open mucus fistula usually in the left iliac fossa (LIF). This facilitates localisation of the rectal stump if further surgery is contemplated but leaves the patient with two stomas and is poorly tolerated. A closed rectal stump sutured to the rectus sheath in the lower aspect of the midiine wound has been advocated. This avoided a troublesome mucus fistula routinely, but if dehiscence of the rectal stump occurred, allowed this to discharge into the wound, avoiding intra-abdominal sepsis. However, significant contamination may develop in the midline wound predisposing to wound disruption/dehiscence and slow healing. We propose the closed cutaneous LIF mucus fistula as a novel but preferable technique.