The dilemma of preservation of the rectum: Retention of the rectum in colectomy for inflammatory disease of the bowel

Retention of the rectum in colectomy for inflammatory disease of the bowel minimizes operative morbidity and mortality, especially in emergency operations. When a normal rectum is a requirement for ileoproctostomy, however, very few patients will be candidates, and most of these will have Crohn's disease. In this series, the rectums were retained initially in 58 of 100 patients undergoing colectomy, but only nine patients had ileoproctostomy primarily or secondarily, and only three patients maintained that arrangement over the long term. This policy is biased against ileoproctostomy, but when the rectum is involved by inflammatory disease, it is advisable to do a proctectomy to eliminate the risk of cancer and to restore patients to productive lives.