Post-operative Dysfunction of the Ileostomy in Ulcerative Colitis and its Prevention

Experience with 230 patients suffering from ulcerative colitis shows that procto-colectomy is the method of choice in surgical treatment. Ileostomy alone is not sufficient, but nevertheless it remains a more important part of the operative treatment than the much more extensive procedure on the colon because of the psychological and biological effects and because it is liable to more dangerous complications. Indications for surgery include not only urgent complications (such as perforation, bleeding, obstruction or cancer), but also certain severe forms of the disease. Disturbance of function is a more important indication for surgery than anatomical changes. Pseudopolyposis or fibrosis of the colon alone are not recognised indications because among our 230 patients we have not so far come across a single case of cancer. It is therefore our opinion that inflammatory pseudopolyposis is not such a serious precancerous state as adenomatous polyposis of the intestine. We operated upon about 20% of our patients for one or other of the indications mentioned.