DOP067 Risk of malignant and non-malignant complications of the rectal stump in patients with inflammatory bowel disease
Bogaerts J.*1, Ten Hove J.R.1, Laclé M.M.2, Meij V.3, Oldenburg B.1
1University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands 2University Medical Center Utrecht, Department of Pathology, Utrecht, Netherlands 3University Medical Center Utrecht, Department of Surgery, Utrecht, Netherlands
A considerable number of patients with inflammatory bowel disease (IBD) have refractory disease and therefore often require a subtotal colectomy with construction of an ileostomy. When pouch surgery is not appropriate this can be a definitive procedure. Due to the potential risk of pelvic nerve damage and pelvic septic complications, the rectum is often left
In a single tertiary referral centre, a diagnostic coding system was used to identify all patients with IBD and a history of colonic resection. Patients were stratified according to the presence of intestinal continuity (ileorectal anastomosis [IRA] and ileal pouch anal anastomosis [IPAA]) or discontinuity (ostomy with or without remaining RS). Additional demographic and clinical data were collected for patients with bowel discontinuity. Endoscopically confirmed diversion colitis, stenosis or shortening of the colon were defined as benign RS complications. Neoplasia was defined as the presence of low-grade dysplasia (LGD), high-grade dysplasia (HGD) or carcinoma in the RS.
Out of 1787 patients with IBD, 352 had 1 or more colonic resections. The final anatomical status was IRA in 25 patients (7.1%), IPAA in 89 patients (25.3%) and a colo-/ileostomy in 238 patients (67.6%). In 197 patients a RS had been
In patients with IBD and a retained RS after colectomy a high prevalence of diversion colitis and RS stenosis was observed during endoscopic follow-up. Cancer occurred in 5 out of 197 patients with an incidence rate of 3.0 per 1000 patient-years.