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Invited Critique
May 2013

The Out-of-Circuit Rectum in Ulcerative Colitis: The Bumpy Road Less TraveledComment on “ Fate of Rectal Stump After Subtotal Colectomy for Ulcerative Colitis in the Era of Ileal Pouch–Anal Anastomosis”

Author Affiliations

Author Affiliations: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

JAMA Surg. 2013;148(5):412. doi:10.1001/jamasurg.2013.2330

Historically, subtotal colectomy has been one option for patients requiring surgery for ulcerative colitis. It is performed in severely ill patients who are uncertain of their diagnosis or desire to have this procedure.1,2 At a future date, patients may undergo a completion proctectomy with an ileoanal anastomosis, a proctectomy with an end ileostomy, or, exceedingly rarely, an ileorectal anastomosis.3 However, a cohort of patients continue to retain their rectal stump for a significant period for a variety of reasons, including but not limited to health-related reasons, caution regarding impotence until childbearing years have passed, concerns about the functional results of a restorative procedure, or the fear of an eventually permanent stoma. On the other hand, concerns about cancer in the retained rectal stump, continued symptoms from the retained rectum, and the need for continued surveillance of the rectal stump all preoccupy both the patient and the physician in optimizing the patient's care. Decision making among patients with a retained rectum following subtotal colectomy may be problematic, and the best option may be delayed for the heretofore listed reasons as well as loss of patient follow-up.4

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